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Tilting at Windmills

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April 6, 2006
By: Kevin Drum

CRANKY ABOUT HEALTHCARE....T.J. Simers is an LA Times writer whose schtick is cranky sports columnist, but today he plays cranky healthcare critic:

TRUE STORY. I can barely walk, suffering a serious knee injury while on assignment in Las Vegas....I called my doctor (he was in Hawaii), got sent to urgent care, where they took their time, went for an X-ray because an MRI exam on our HMO plan is obviously too expensive, and was told to wait for the guy to get back from Hawaii.

He returned, telling me how much it rained while he was there, and referred me to a shoulder specialist.... I switched to a knee guy...and who knows if he's any good?....I've been given no choice, and now I've been told I have to wait 20 days to see [him].

...."I'm just supposed to limp around in pain for the next 20 days?" I asked the appointment clerk, and she said, "Yes."

....The guys in the office said they had similar problems with HMOs, and weren't surprised with my Cigna plan, which is apparently designed to prolong pain in the hopes it might go away before someone forces Cigna to pay for a MRI or treatment.

See, that's why we can't have single-payer healthcare in the United States. It might lead to something like this:

The health system in France is regarded as delivering high quality services, with freedom of choice and generally no waiting lists for treatments. Access to medical services is equal among the population and, unlike in some other countries, people can get the treatments they need irrespective of their social status or work situation.

It costs less too. Can't have that, can we?

Kevin Drum 8:37 PM Permalink | Trackbacks | Comments (213)

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It costs less too. Can't have that, can we?

I imagine the real problem is (and someone more familiar with France's system can correct me and/or expand on this) that no one in France is becoming obscenely wealthy as a provider, purveyor, marketer, recorder, or denier of health care. We really can't have that.

Posted by: latts on April 6, 2006 at 8:42 PM | PERMALINK

I read that this morning, and I'll say that at least Simers's doctor was telling the truth about rain in Hawai'i. We had a spate of 43-44 consecutive days of rain out here, which hasn't occurred since 1951 or thereabouts.

Posted by: Linkmeister on April 6, 2006 at 8:44 PM | PERMALINK

But isn't TJ just Bush's savey healthcare consumer, making sensible choices? Single payer now!

Posted by: Tigershark on April 6, 2006 at 8:44 PM | PERMALINK

Socialized medicine is worthless. My sister's neighbor's milkman's son's teacher has an uncle in Canada who got a letter saying his wife was now at the top of the list for her brain transplant the day after she turned into a zombie and killed an entire town.

Posted by: joshua on April 6, 2006 at 8:45 PM | PERMALINK

Give it up Kevin, it's Communism.

Oh, and those French cheeses? They're all moldy.

Posted by: alex on April 6, 2006 at 8:45 PM | PERMALINK

My fiancee is going through something that sounds almost exactly like that. Except she's in so much pain she can barely get out of bed some days. And the doctors her HMO sends her to have no idea what it is. And everything they tell her to do makes her feel worse.

Posted by: Balta on April 6, 2006 at 8:49 PM | PERMALINK

If someone went around kneecapping sports writers we might get some press attention on this disgraceful insurance system.

Posted by: undersiege on April 6, 2006 at 8:51 PM | PERMALINK

Their women are hotter too--except when they're rioting.

Posted by: Chocolate Thunder on April 6, 2006 at 8:54 PM | PERMALINK

Balta I'd say do some research on fibro myalgia, except I can't spell it. Very sorry for your fiance.

Posted by: undersiege on April 6, 2006 at 8:55 PM | PERMALINK

And most important today, none of this would be addressed by the so-called health reform just passed in Massachusetts.

Posted by: Bob N. on April 6, 2006 at 8:56 PM | PERMALINK

The conservative position on all this is that the American health care system is ten times better than any country's single-payer one, because it is market-oriented. And we need to make it yet more market-oriented so it will become even better.

Posted by: Les B on April 6, 2006 at 9:01 PM | PERMALINK

Simers really is a horses ass. Witness his ranting about the Angels in general, and Garrett Anderson specifically in last Sunday's LATimes.

He really pissed Pam off.

Meanwhile, Pam's son Jim got some medical treatment when he was in France around Christmas, I'll get details for you. He said it was better treatment than when he actually worked for Kaiser Permanente.

Posted by: SteveAudio on April 6, 2006 at 9:05 PM | PERMALINK

I find it very bizarre when I start talking about healthcare with my relatives and they go into thier list of awful things that have happened to thier freinds and relatives that will happen to us if we have universal healthcare. It is bizarre because all of their freinds and relatives problems occured in the US.

Posted by: jefff on April 6, 2006 at 9:06 PM | PERMALINK

Providing health care for employees is killing many American companies; Auto makers, airlines. Do the Republicans want to see them all go under, with the jobs going off-shore and the left over workers at Wal-Mart?

Posted by: Hedley Lamarr on April 6, 2006 at 9:09 PM | PERMALINK

Over the course of my life I've been sick and/or needed medical attention of some kind or other in Britain, France, Germany, Sweden, Norway, Venezuela, Singapore, Kenya, Thailand, Australia, Israel and the US, and the place I'd least want to get sick again is the US. Not for the quality of the treatment (though it varies wildly at best) but for the potential cost. It's the only place I know where having one's finances ruined because of a serious illness or injury is considered routine.

Posted by: Stefan on April 6, 2006 at 9:15 PM | PERMALINK

Don't you know our problem is that we have too much health care. Market forces prevent this man from over using doctors...

Seriously, a campaign slogan for the HSAs: "HSAs: Because you are really overinsured!" It's not misleading--it's what they say.

Posted by: gq on April 6, 2006 at 9:15 PM | PERMALINK

Mass. health care reform is a crock.

Wish I could get a law passed saying that everyone has to by *MY* products.

Alas, I lack the cash.

It's like "No fault" in CA. (I talked to my insurance agent about it. He said they had a party when it passed.)

Posted by: Toner Cart. on April 6, 2006 at 9:17 PM | PERMALINK

Do the Republicans want to see them all go under, with the jobs going off-shore and the left over workers at Wal-Mart?

Yep, pretty much. As long as they get theirs, fuck everyone else.

Mind you, we're talking about the people at the top of the party here, the big money contributors and their lackey politicians. The ordinary common Republican voter is a poor dupe who's been brainwashed into voting against his own best interests.

Posted by: Stefan on April 6, 2006 at 9:17 PM | PERMALINK

"by" = "buy"

Posted by: Toner Cart. on April 6, 2006 at 9:21 PM | PERMALINK

To save everybody time and effort, here are the standard conservative responses to any discussion of health care reform:

1. Single payer plans are socialistic and therefore ipso facto evil.
2. I know someone who knows someone who's related to someone from Canada who had to wait for tennis elbow surgery for months and months and came to the US and he had the surgery immediately and it saved his life.
3. Look what's happening in France right now; their health care is socialized and there are riots in the streets.
4. We have the best health care in the world and anyone who says otherwise is part of the blame-America-first liberal socialistic treasonous left.
5. Anybody who wants insurance coverage can get it, and the only reason some people don't it's because they don't want to.
6. People who get sick got sick because they weren't paying attention to their diets, etc. and they are therefore to blame for their problems; why should the taxpayer pay for lazy people who sit around eating hamburgers and watching TV and so get fat and sick?
7. Those who can't afford health care cannot do so because they are lazy and do not work hard enough to afford to pay for what they need in life and so they want me to pay for their expenses.
8. Those with children who cannot afford health care for their children shouldn't have had any children and to have done so was irresponsible; if we reward them with free health care they'll never become responsible.
9. Italians are disappearing because they don't reproduce enough, and they have socialized medicine, which obviously has not helped them to continue surviving as an ethnic group.
10. What we need is to promote preventive medicine so that nobody gets sick again.
11. All we need to do is make sure insurance companies do not have to pay any taxes whatsoever, which will undoubtedly lead to more competition, better care and lower prices.
12. Cuba has socialized medicine; you want to live in Cuba?
13. All statistics quoted by supporters of socialistic remedies to health care are false or faked, a priori; all anecdotes offered by opponents of health care are true and accurate, a priori.
14. With socialized medicine, research into new drugs and therapies will stop immediately, because it is the current healthy competition among our insurance companies that directly drives medical research.
15. Our problem is too much health care, and people tend to abuse the system by going to the doctor too often. With socialized care, we'll get even more abuse, while the market forces of free capitalism will discourage the slightly sick from tying up the system with complaints about sniffles.
16. The problem with health care is Medicaid and Medicare, which encourage the poor and the old to get sick more often.

Note that this this is a continuously refined list that I try to post every time Kevin mentions "health" and "care" in the same sentence; you should feel free to add more responses so that we can have a more comprehensive list for next time.

Posted by: Aris on April 6, 2006 at 9:27 PM | PERMALINK

I got strep throat in France about ten years ago. The hotel called a doctor to see me(house call!). He gave me a thorough exam, three prescriptions, and a lot of kindness. His visit cost me 27 dollars; the three scripts came to 21 dollars. What a system:J'aime la France! People against universal health care in the States ALWAYS bring up Canada or Britain as examples of how inefficient such systems can be; they NEVER bring up France, Germany, Sweden or Hawaii.

Posted by: beth on April 6, 2006 at 9:29 PM | PERMALINK

And don't forget the bogeymen Republicans always wheel out of the closet to scare people about single-payer:

1. You have to wait for treatment!!!!! (Yeah--like you don't have to wait now.)

2. But some faceless bureaucrat will make your healthcare decisions!!!! (Uh-huh--as opposed to the faceless insurance bureaucrat who's making those same decisions today based on what makes the most profit for his employer.)

3. You won't be able to choose your doctor!!!! (Definitely--which explains why HMOs and PPOs restrict which doctors you can see, and will NOT let you see a specialist of any kind without a referal from your primary doctor, review by the insurer's medical board, and approval from billing and accounts [provided said specialist is in their system to begin with])

Posted by: Derelict on April 6, 2006 at 9:31 PM | PERMALINK

What a textbook case of dishonest quoting. The sentence immediately afterwards reads: "The system is expensive, however, and consumed a growing proportion of national income up until the mid-1990s (Figure 2). Upward pressure is exerted on spending by the use of expensive technology as well as the freedom of choice enshrined in the French system that allows patients to consume as much they want, and health care professionals to prescribe freely."

Now, the next paragraph mentions efforts to control spending, and "...these measures have had a real but limited impact on the overall rise in spending. Initiatives to modify incentives and behaviour have either been insufficient or slow in their implementation. A new impetus is needed to complete the efforts to date, while safeguarding the major strengths of the French system: quality of care, freedom of choice and equity of access."

In short, you can have an ideal single-payer system with plentiful resources and choices, but it'll cost you, and plenty.

Now, considering how eager Kevin and others are to import tens of millions of people who will consume more government resource than they'll pay in taxes, I don't see France's system in our future. It's doubtful that it'll even be in France's future for that matter.

Posted by: Derek Copold on April 6, 2006 at 9:36 PM | PERMALINK

Aris, you can write this better but the main delusion I find annoying is that the reason our health care costs are rising is because of the wonderful technology and advanced treatment Americans get ...except for those lazy stupid people who get the finest technological care and use it too often... but remain sick, ... or something like that.

Posted by: undersiege on April 6, 2006 at 9:39 PM | PERMALINK

Derek Copold: Now, considering how eager Kevin and others are to import tens of millions of people who will consume more government resource than they'll pay in taxes, I don't see France's system in our future. It's doubtful that it'll even be in France's future for that matter.

Sure, sure, you're so right... But what exactly is your solution? Come on, don't be shy! Share with us...

Posted by: Richard Kilborn on April 6, 2006 at 9:41 PM | PERMALINK

Maybe the problem is that supporters of universal healthcare with prominent soapboxes spend more time snarking and less time discussing the actual concrete proposals out there, like California's SB840, which might actually help get something done.

Seems that the only time any of the concrete proposals get discussed on the front page here, for instance is when, as in Massachussetts, they get passed, rather than when discussing them might affect their prospects.

Posted by: cmdicely on April 6, 2006 at 9:44 PM | PERMALINK

Now, considering how eager Kevin and others are to import tens of millions of people who will consume more government resource than they'll pay in taxes, I don't see France's system in our future.

Why? Because there is some danger that years down the road, the French system might be as costly as the US system is now, while the US system is getting more expensive even faster than the French?

Yeah, sure, a system like France's is expensive -- unless you compare it to a system like the US has already.

Posted by: cmdicely on April 6, 2006 at 9:46 PM | PERMALINK

Derek Copold said: "In short, you can have an ideal single-payer system with plentiful resources and choices, but it'll cost you, and plenty."

No, it will cost the insurance industry. That's why we're not like likely to see single payer here.

We're talking about *nationalalizing* an "industry" (really a financial scam), and the ruling class won't sit still for that. Do you really think they're on your side?

Posted by: Toner Cart. on April 6, 2006 at 9:46 PM | PERMALINK

Sure, sure, you're so right... But what exactly is your solution? Come on, don't be shy! Share with us...

Pick a pair of parents with good genes and don't get sick.

Posted by: Derek Copold on April 6, 2006 at 9:51 PM | PERMALINK

...the French system might be as costly as the US system is now, while the US system is getting more expensive even faster than the French?

Sure, increase government allocations, such as the prescription drug plan, and the price will rise.

No, it will cost the insurance industry. That's why we're not like likely to see single payer here.

They're certainly part of the problem. I just don't the government in this country acting as much of a solution.

Posted by: Derek Copold on April 6, 2006 at 9:55 PM | PERMALINK

This is an interesting case, emphasizing one of the points I have been making about healthcare inequality in the US, while also making Mr. Drum's major case for a better healthcare system. This Simmers bloke complains because he has to wait only twenty days for treatment, I doubt very much if he did not at least obtain a pain killer 'script (I always receive them), while a huge percentage of the population who do not have insurance still have to either go to their labor jobs or forgo pay without ever having hopes of receiving adequate timely treatment. The upper middle class acts as if healthcare were an entitlement available on demand, which is an expensive form of healthcare, and this selfishness contributes to preventing the kind of system Mr. Drum rightly thinks can provide egalitarian services to the entire population.

Posted by: Hostile on April 6, 2006 at 9:55 PM | PERMALINK

Do you really think they're on your side?.

As opposed to the buffoons in Washington who refuse to defend the border? Bad as the insurance people are, I can still have options, limited as they may be.

Posted by: Derek Copold on April 6, 2006 at 9:57 PM | PERMALINK

Derek Copold: Pick a pair of parents with good genes and don't get sick.

You did not disappoint. As vapid as comment as I had expected.

Posted by: Richard Kilborn on April 6, 2006 at 9:57 PM | PERMALINK

I will agree with Derek Copold that as long as the federal government in the hands of Bush and his buffoons, no system, regardless of how well designed it is, can be implemented in any competent way.

Posted by: Aris on April 6, 2006 at 10:01 PM | PERMALINK

You did not disappoint. As vapid as comment as I had expected.

You want a solution to complex problem in a comments section of a blog? My answer may have been vapid, but it's exactly the one you deserve.

Posted by: Derek Copold on April 6, 2006 at 10:02 PM | PERMALINK

Careful everybody. You're about to scare Derek Copold off. We've been trying to bait a troll on the MA healtcare item. No bites. They're all scared off.

Probably the single most important item, literally for the health of the nation with all the boomers coming through and costs out of control. What a surprise! Not only no hint of any solution. Not even a decent argument.

How bankrupt is that. Health care is only for the top 20%. If that!

Posted by: notthere on April 6, 2006 at 10:02 PM | PERMALINK

[Jeff..they go into thier list of awful things that have happened to thier freinds and relatives that will happen to us if we have universal healthcare. It is bizarre because all of their freinds and relatives problems occured in the US.]

Jeff you can shut these arguments down if you take the time to learn about UNDERWRITERS, the cloistered corpus dei of the corporate world, the rainmakers, the hidden bankers. Tell them they pay these people a nice corporate salary to scrutinize their health records to decide if their rates are going up, or if they should be cancelled.

There are very few laws to protect ins. buyers from these secret men in black. There are many legal loopholes allowing them to cancel insurance on people who need it the most.

Posted by: undersiege on April 6, 2006 at 10:02 PM | PERMALINK

When I lived in Brussels I had great health care. It was a requirement for the visa that I get it. Could choose among several options as well. the level of service and professional care was great. Even had a house call once when I spiked a fever of 104 and was not able to walk unassisted. If only here.

Posted by: moe99 on April 6, 2006 at 10:03 PM | PERMALINK

I will agree with Derek Copold that as long as the federal government in the hands of Bush and his buffoons, no system, regardless of how well designed it is, can be implemented in any competent way.

I'm no fan of Bush, but this underlines the point. By turning things over to the government, you basically put yourself at the mercy of whoever comes to power. Sure, you can vote them out next election, but that'll be years away.

We've been trying to bait a troll on the MA healtcare item. .

Let's see how it does before we comment. If the people of MA want to do this, good for them. I'm a big fan of federalism. If it works, others can duplicate it. If it doesn't, I'm sure y'all will have a slew of excuses for it.

Posted by: Derek Copold on April 6, 2006 at 10:06 PM | PERMALINK

Derek Copold: You want a solution to complex problem in a comments section of a blog? My answer may have been vapid, but it's exactly the one you deserve.

Hmm... You have no problem attempting to debunk proposed solutions to our health care crisis made in a blog in the very comments' section of said blog, but when asked to provide your own proposed solution you don't think it's appropriate to comment in the comments' section of a blog because the subject is too "complex"?

Don't mean to insult you, but that's even more vapid that your earlier flippant comment.

Posted by: Aris on April 6, 2006 at 10:14 PM | PERMALINK

Having sex with Frencmen again are we.

Let me point out that the French, the native French are dying off, mainly because they cannot afford families. They have about 50 years left, and most of that will be spent trying to pay off the underclass immigrants.

That is socialized welfare, and it is happening across Europe.

Oh, but wait, you tell me, smaller, less fertile families is a choice. Sure, but it is a choice so bad that it no longer makes sense to offer healthcare to an aging population funded off the backs of poor immigrants.


Posted by: Matt on April 6, 2006 at 10:17 PM | PERMALINK

[Derek...By turning things over to the government, you basically put yourself at the mercy of whoever comes to power. Sure, you can vote them out next election, but that'll be years away.]

I could see myself rioting in the street, instead of a Mexican flag it could be a red cross flag, or a sign like the Katrina victims, PLEASE HELP US... If you could get it on TV politicians would run for cover. But the teevee wouldn't cover it, that's the only problem.

Posted by: undersiege on April 6, 2006 at 10:19 PM | PERMALINK

But isn't TJ just Bush's savey healthcare consumer, making sensible choices?

I've personally come along way toward single payer (thanks Kevin!) but this is absolutely an example of someone making BAD healthcare choices. And perhaps, then, another argument for getting rid of these choices.

I spend a lot of time dealing with healthcare issues (always reading the available plans, taking the highest monthly charges, etc.) and I have also worked the public systems in San Francisco County, Alameda County and Washington, DC.

And I've never had this problem. Ever.

And let me tell you also, I visit a doctor over 4 times a year, I have yearly MRIs and other tests. But getting all this covered means that I automatically pick the plan that will cover MRIs at 100%. I spend weeks researching doctors -- always picking people at the top of their profession, or those that have a strong commitment to being leaders in local public health issues. When possible, I choose the doctor affiliated with a local med school.

But all of this (and here's where I've started to rethink this) is TIME CONSUMING. And means that I bought my car with less thought. I know the ins and outs, when a doctor is good or bad. A consumer-driven healthcare system means that you have to be SMART consumers. And put yourself in a position to be at the receiving end of the best care -- being picky about jobs, living only in cities or states with quality care.

And so of course this is all why I've come to agree with Kevin. It doesn't seem like something so basic should require this much work. Unless it's some sort of natural selection program -- but we all know conservatives don't believe in natural selection so that can't possibly be it. Right?

Posted by: dC1974 on April 6, 2006 at 10:22 PM | PERMALINK

Matt says, the aging French are paying off the underclass immigrants... But, at the same time he's saying the immigrants poor hard working backs are paying the cost of the health care system. Which is it? Are the immigrants being paid off, or are they paying? I'm confused.

Posted by: undersiege on April 6, 2006 at 10:28 PM | PERMALINK

Good grief! Last week I developed an increasingly painful pain in my shoulder, without any identifable causation. I had some conjectures, but, hey, it really didn't matter as I could barely move my arm away from my side, it ached down to my finger tips, and I could barely sleep even with several pillows to prop up my arm and more banked around it so I wouldn't move if I fell asleep.

Made appt. for Friday; pain increased overnight, was horrible.I tried to get into my GP/gatekeeper on Saturday as it was markedly worse on Saturday than it had been on Friday. I was able to get an appt. on Monday, where I was given a diagnosis and told to make an appt with an osteo ASAP.

GP said she would give me authorization for imaging, x-ray for bone, MRI for soft tissue, so I would have it for the appt with specialist. However, per her office people, no could do the MRI before 72 hours at least.

Began pain pills, but used only at night.

Made appt. for Friday; pain increased overnight, was horrible, and I begged for earlier appt. Got one for Tuesday afternoon. Oster wanted imaging, especially MRI, as my symptoms didn't fall into a neat diagnosis.

His office was able to get me in for an x-ray immediately, but, tah-dah!, Aetna has another group, called Care Corps, which give "certification numbers" for certain diagnostic tests and determines "the best" diagnostic. Huh???

And takes at least 72 hours to do so.

When I was diagnosed with possible cancer and the surgeon wanted an ultrasound, Care Corps gave his office a cert number immediately.

And I was in no pain. Now that I'm in major pain, they're taking it long and slow and, just like the guy writing the article, hoping I'll commit suicide from the pain before they have to allow an MRI.

What a health provisioning system!

A friend's son blew out a knee when he was out for Christmas. His HMO said he could get palliative care and immediate stabilization at ER, but anything else, like repair which should be done sooner rather than later, had to be done in his home region.

Since he drove out to his parents' home, they had the choice of driving him the 1000+ miles back to his home, with the drivers flying pay for airfare, or paying for his airfare--and having a cramped ride. They chose driving so he could stretch out.

Best health care system in the world. Not.

Posted by: jawbone on April 6, 2006 at 10:28 PM | PERMALINK

Don't mean to insult you...

Yes, you do. But that's okay, I have a thick skin, and since I dish it out, I should be able to take it.

...but that's even more vapid that your earlier flippant comment.

My comment was the best solution to the problem, because anyone coming along suggesting they can solve the problem is lying to you. In fact, that's sort of what Kevin wound up doing when he selectively chopped off the downside of the report.

Now, some countries can control their government spending and their citizens can refrain from abusing services they don't need. The Japanese and some of the European countries fall into this category. Ours does not. Every government program we've established has ballooned in size, growing larger and larger and larger, outstripping the private sector. Nothing leads me to believe that a Universal Healthcare System will be any different. In fact, it'll probably be even worse than average, as we get confronted with every hard case that comes down the pike.

Now this doesn't mean government doesn't have a role to play. There is a place for them, perhaps, when it comes to catastrophic cases (which are relatively rare). Where this line is drawn, I don't know. I'm not an expert. But I do know that I don't want them to get into the business of paying for routine medicine.

Posted by: Derek Copold on April 6, 2006 at 10:31 PM | PERMALINK

"As opposed to the buffoons in Washington who refuse to defend the border?"

Yeah, I'll put my faith in the insurance industry, now that you oppose them to the members of the ruling class who refuse to defend the borders. Who do you think benefits from exploitation of illegal immigrants? (Hint: Walmart, Marriot, Hilton, McDonalds)

Posted by: toner Cart. on April 6, 2006 at 10:33 PM | PERMALINK

Who do you think benefits from exploitation of illegal immigrants? (Hint: Walmart, Marriot, Hilton, McDonalds)

And don't forget Joe Average who runs over to the Lowe's to get some quick help building his deck.

I understand the corporate role in the problem. I never said they were angels. But with them, I have something of a choice between evils, and that's some leverage, though not a lot.

Posted by: Derek Copold on April 6, 2006 at 10:36 PM | PERMALINK

"though not a lot."

As long as you've got some little thread to hang onto.

Posted by: toner Cart. on April 6, 2006 at 10:37 PM | PERMALINK

Right now on The History Channel, two hours of 'Bible Battles: Exploring the Biblical world from a military perspective.'

Posted by: cld on April 6, 2006 at 10:40 PM | PERMALINK

In his 9:36 PM post, Derek Copold accuses Kevin Drum of dishonest quoting for leaving out the following paragraph that talks about the high cost of France's system. What Derek dishonestly overlooks is that despite the cost "problems" which the French are aware of and working to correct, their system costs significantly less on both a per-capita basis and as a percentage of GDP than does the U.S. system.

Posted by: tanj on April 6, 2006 at 10:40 PM | PERMALINK

This is not a good example to illustrate failings with the system. This guy did not need an urgent MRI, the urgent care doc should have braced the knee if unstable, prescribed adequate medication and anti-inflammatories (I assume he did those things) and arranged timely followup.

Believe me, especially in today's litigious atmosphere, if a test needs to be done right away, it gets done.

The appointment clerk was definitely out of line if she actually said what he claims. I'm not sure that this kind of thing is unique to the health care system. I hear people in France can also be rude.

Posted by: Brian MD on April 6, 2006 at 10:48 PM | PERMALINK

When presented with myriad examples of all other industrialized countries which provide better care for lower cost than we do, the trolls fall back to their second position, which is, essentially, that that may be true for those countries, but that it couldn't possibly work here. Why? Well, that's never quite clear.

They remind me of the old joke about the economist who says "yes, yes, it works in practice, but does it work in theory?"

Posted by: Stefan on April 6, 2006 at 10:54 PM | PERMALINK

In his 9:36 PM post, Derek Copold accuses Kevin Drum of dishonest quoting for leaving out the following paragraph that talks about the high cost of France's system.

Actually, he left out the following sentence, the sentence with the "however." I quoted the rest of the paragraph, and the following paragraph which mentioned the French attempts to control costs (those attempts being increasing privatization).

What Derek dishonestly overlooks is that despite the cost "problems" which the French are aware of and working to correct, their system costs significantly less on both a per-capita basis and as a percentage of GDP than does the U.S. system.

I'm not pretending our service is perfect. Kevin was. And the French rate of growth is hardly peanuts either. It's the fourth largest per GDP number and it's growth is only slightly smaller than the U.S. Again, considering the way U.S. bureacracies tend to bloat, importing the French system here would probably bankrupt us, or force us to go to rationing.

Posted by: Derek Copold on April 6, 2006 at 10:55 PM | PERMALINK

1. One of the things universal healthcare is worst at is MRI access

And on page 8, the US has 66 % specialist coverage, France 50%. They'd probably have treated the issue with a GP.

Now in the US, you can't say I'll take a less qualified doctor instead of waiting. Lawsuits. So its the defensive medicine that's the issue not the universal.

2. "generally no waiting" in the paragraph you sited is open to interpretation.

Why don't you look at Mass-chu-setts and see what happens instead of academic papers. Fact is you can find an academic paper that supports anything where as Kerry-land is actually trying to do it.

Posted by: McA on April 6, 2006 at 10:56 PM | PERMALINK

Good job Derek, you posted that just in time to provide an example to illustrate Stefan's point.

Posted by: tanj on April 6, 2006 at 10:57 PM | PERMALINK

tanj, you're quite right, of course, but people like Derek Copold are special: their arguments are ideological, based on faith, and thus immovable by real-world evidence. If you read his comments, he eventually fesses up that he just doesn't want the government involved, period, because governments are always venal, incompetent, etc, and they take choice away from us. Classic libertarian BS.

One could point to many governments programs that are far more efficient and cheaper than anything private industry can produce, as long as we bother to vote for competent people (e.g. Medicare, especially before Bush's recent prescription drug debacle); one could point to many industries failing over and over, with or without government welfare (e.g. airlines); one could point out that with government you do get a choice as long as we're a democracy, but you get scant choice with private oligopolies (e.g. health insurance).

None of this matters. In his Alice in Wonderland world, ideology comes first, it dictates the conclusion, and evidence is selected to support the ideology.

Posted by: Aris on April 6, 2006 at 10:57 PM | PERMALINK

Brian MD, people are boiling mad over the profit driven health care system here. The suspicion will always be that they don't get care cause someone wants to make a buck. It's an anything-for-a-buck society and doctors will have to deal with nastier and nastier complaints. So the clerks get nasty and defensive and we're all in this profit driven hell together.

Posted by: undersiege on April 6, 2006 at 10:57 PM | PERMALINK

Why? Well, that's never quite clear.

I have made my position on the matter clear. The U.S. government has a very hard time saying "no" to spending requests. Look at actual Medicare and Medicaid expenditures compared to the projections. The former are several times larger than the latter. Why should we believe that a Comprehensive Government Health Service will be any different?

Posted by: Derek Copold on April 6, 2006 at 10:58 PM | PERMALINK

Now, some countries can control their government spending and their citizens can refrain from abusing services they don't need. The Japanese and some of the European countries fall into this category. Ours does not. Every government program we've established has ballooned in size, growing larger and larger and larger, outstripping the private sector. Nothing leads me to believe that a Universal Healthcare System will be any different. In fact, it'll probably be even worse than average, as we get confronted with every hard case that comes down the pike.

Ah. So, essentially, the problem is that as compared to the citizens of all other industrialized countries Americans are so uniquely stupid, greedy and/or incompetent that they will simply fuck this up. I see the right-wing's Blame America First complex is not quite dead yet.

Posted by: Stefan on April 6, 2006 at 10:58 PM | PERMALINK

importing the French system here would probably bankrupt us, or force us to go to rationing.

What is this "go to" rationing? We have rationing here already, and always have -- it's rationing by cost. Can't pay, you don't get treated. Every single HMO and insurance company in this country "rations" care, mainly by denying coverage and hoping their claimants will give up and go away.

Posted by: Stefan on April 6, 2006 at 11:00 PM | PERMALINK

If you read his comments, he eventually fesses up that he just doesn't want the government involved...

Uh, no, Aris, that is NOT what I said. I said I can see a role for them, along the lines of taking care of catastrophic medical needs. And I really can't define that line. What I don't want the government doing is looking after routine non-catastrophic stuff.

Posted by: Derek Copold on April 6, 2006 at 11:01 PM | PERMALINK
Socialized medicine is worthless. My sister's neighbor's milkman's son's teacher has an uncle in Canada who got a letter saying his wife was now at the top of the list for her brain transplant the day after she turned into a zombie and killed an entire town.

Diet Coke just shot out my nostrils ...

Posted by: zeeeej on April 6, 2006 at 11:01 PM | PERMALINK

It costs less too. Can't have that, can we?

Nope.

You are a nation of obese pigs who don't even know how to wash your hands after you shit.

France is not.
They are slim, healthy, sexy, and clean.

If the French were as obscenely fat and finger-nail dirty as most Americans... they wouldn't be able to afford national health care either.

Sorry to be so honest.

But you people really are disgusting.
Look in the national mirror.

I mean really... you people still lead the Western world in Syphillis.

You can't even fuck clean...

Posted by: koreyel on April 6, 2006 at 11:01 PM | PERMALINK

So, essentially, the problem is that as compared to the citizens of all other industrialized countries Americans are so uniquely stupid, greedy and/or incompetent that they will simply fuck this up.

Well, compared to some countries. The Germans, Swiss and even the French are certainly trying to catch up.

I see the right-wing's Blame America First complex is not quite dead yet.

Hey, we need to be honest with ourselves. We're not the Japanese. If you want to call that "Blame America First", have at it.

Posted by: Derek Copold on April 6, 2006 at 11:04 PM | PERMALINK

Matt: Let me point out that the French, the native French are dying off, mainly because they cannot afford families. They have about 50 years left, and most of that will be spent trying to pay off the underclass immigrants.

Thanks Matt! Number 9 in my list of utterly predictable conservative talking points against any rational health care reform (see above) states that, "Italians are disappearing because they don't reproduce enough, and they have socialized medicine, which obviously has not helped them to continue surviving as an ethnic group." Why, I didn't know the French are vanishing also! I'll make sure I add you version.

Posted by: Aris on April 6, 2006 at 11:04 PM | PERMALINK

Health care spending in America wouldn't be so ruinously high if we didn't demand absolutely unlimited end-of-life care, even when the chances of survival and quality of life are both zero. Europeans are much more realistic about life and its limits.

Posted by: Peter on April 6, 2006 at 11:07 PM | PERMALINK

What is this "go to" rationing? We have rationing here already, and always have -- it's rationing by cost. Can't pay, you don't get treated.

That's true, but with our system, you still have some incentive to lower costs, and you still have some latitude. If you're insurance doesn't want to cover something, you can pony it up yourself. Under the single-payer system, you often can't do this. Thus we see Canadians coming over here when they need medical care. Even the French came to this realization and they've been trying to privatize portions of their health care.

Of course, you're going to complain that the poor suffer, and that's true. But under a government system they would as well, and the rich (or rather the politically connected) would still be taken care of.

Posted by: Derek Copold on April 6, 2006 at 11:10 PM | PERMALINK

Did I just count three people complaining that they couldn't get an MRI for three days or fewer? If that is your complaint it won't be getting better under any of the central systems.

Posted by: Sebastian Holsclaw on April 6, 2006 at 11:11 PM | PERMALINK

Cranky...Bet your ass I'm cranky...

little_grape had her second ear surgery this past Monday morning...90% hearing loss in one ear, 40% in the other...Tubes inserted again; the first time was back in October. My new insurance didn't cover the second trip; they considered it to be a pre-existing condition and said that the procedure was elective anyway...Who knew that an insurance company considered hearing optional? I mean, she's only a kindergardener; she has time to catch up, right?

Oh yeah: Even if the procedure was covered, my employer uses one of those high-deductible plans - $4800 yearly max - combined with a HSA account, funded via monthly contributions. Since I just started the plan, I only had about 2 months' worth of savings accumulated.

Originally, the total bill for the procedure was about $9500 dollars...Which the ex-grape and I managed to beg the hospital to cut almost in half...If we paid the amount in full.

So, in the last week, I've spent close to three grand out-of-pocket. Same with the ex-grape. I have an HSA and health insurance through BC/BS...And when those two things did me no fucking good whatsoever, I was also fortunate to have enough cash available to get my kid's 'elective' hearing operation done.

The US healthcare system doesn't work. I want to have a resonable amount deducted from my paycheck in the form of taxes and be able to walk into any doctor's office or hospital, give them my Social Security number, and get what I need to get done, done. I'd like to be able to buy additional health coverage to get it done faster. If I lose my job and get sick or injured, I'd like to not have to sell my house or declare bankruptcy in order to settle the hospital bill.

Please.

Posted by: grape_crush on April 6, 2006 at 11:12 PM | PERMALINK

Why should we believe that a Comprehensive Government Health Service will be any different?

Because, in over 20 other countries, it is better and cheaper. You can look it up in the CIA Fact book if you don't believe me. Or are you saying that the US government is uniquely broken, and despite the dozens of more functional examples to copy from, we will be unable to fix it? (What are you, some kind of defeatist America-hater?)

Posted by: dr2chase on April 6, 2006 at 11:13 PM | PERMALINK

I agree with Peter's comment.

I also feel that the obesity and sedentary lifestyle of Americans must be considered when comparing health care expenditures. The Europeans may smoke more but this is outweighed by their healthier diets and their habit of walking and walking and walking everywhere.

If I were given a sum of money to improve health care in America, I would start by bribing politicians to start taxing fast food and shut down their advertising.

Posted by: Brian MD on April 6, 2006 at 11:15 PM | PERMALINK

Derek Copold: What I don't want the government doing is looking after routine non-catastrophic stuff.

Fine, so you don't want government totally out, just mostly out. I'm glad you cleared that up. Yet, this is still an argument from ideology. It's based on the old libertarian canard that any government program is a priori wasteful, authoritarian, does not provide for choice, etc. etc. Choose your own adjectives.

The implied lie is that all government programs will eventually resemble programs under Soviet bureucracy. This is simply not true. Government works when competent people work for the government. Government is just another human institution, just like private business, and it can work or fail depending on who's in charge.

Posted by: Aris on April 6, 2006 at 11:16 PM | PERMALINK

The last week or so the Charlie Rose show has been having guest hosts. Why? Because Charlie is having heart surgery for a mitral valve. And where is he having this done? New York? Boston? LA? No, Paris. How stupid is he? Doesn't he know the US has the best medical care in the world? Didn't he have health insurance here? Was he put on a 20 day waiting list? Or does he know something the wingnuts here won't admit?

Posted by: karog on April 6, 2006 at 11:20 PM | PERMALINK

Because, in over 20 other countries, it is better and cheaper.

Are we those other 20 countries? No, we are not. You didn't answer the question I put forward. You just threw out an unrelated fact, assuming that our system will work just like the other 20, that is assuming they really "cheaper" AND "better".

Or are you saying that the US government is uniquely broken, and despite the dozens of more functional examples to copy from, we will be unable to fix it?

I didn't say we were "broken," just different. And one of the things about the U.S. is that our government programs have a nasty tendency of growing and growing. This is a documented fact. I cited two examples for of this in the health care field itself.

(What are you, some kind of defeatist America-hater?)

Spare the freepisms. I'm just as leery of Bush as you are.

Posted by: Derek Copold on April 6, 2006 at 11:20 PM | PERMALINK

Derek's grandmothers and great aunts agree with him and probably visit their senators to tell them they want the government to get their hands OFF their Medicare.

Posted by: undersiege on April 6, 2006 at 11:22 PM | PERMALINK

Sebastian Holsclaw: Did I just count three people complaining that they couldn't get an MRI for three days or fewer? If that is your complaint it won't be getting better under any of the central systems.

Yes, Sebastian, the only complaint about our health care system is that MRIs take three days. This is the only problem, and of course central systems (i.e. crypto Soviet) won't help any.

How very perceptive of you! Problem solved since we have no other problems.

Posted by: Aris on April 6, 2006 at 11:22 PM | PERMALINK

It's based on the old libertarian canard that any government program is a priori wasteful, authoritarian, does not provide for choice, etc. etc.

No, it's based on the record of American government programs over the last century or so. They have tended to be wasteful, capricious and averse to providing choice. Now maybe--mirabile visu--this program will somehow, magically, be exempt from that phenomenon. But I doubt it.

Posted by: Derek Copold on April 6, 2006 at 11:23 PM | PERMALINK

D. Copold "If you're insurance doesn't want to cover something, you can pony it up yourself."

If I am insurance doesn't want to cover something, I may not be as well prepared as grape_crush. I am not alone. BTW, isn't that what insurance is supposed to be all about?

Posted by: toner Cart. on April 6, 2006 at 11:25 PM | PERMALINK

Derek's grandmothers and great aunts agree with him and probably visit their senators to tell them they want the government to get their hands OFF their Medicare.

Actually, my mother-in-law has to deal with a lot of the bureaucratic problems that come with Medicare's attempts to control costs. We're stuck with that program, but I don't see why I'd want another one forced on the rest of us.

Posted by: Derek Copold on April 6, 2006 at 11:26 PM | PERMALINK

There is know health care but Single Payer Health Care

Posted by: mark on April 6, 2006 at 11:27 PM | PERMALINK

I am not alone. BTW, isn't that what insurance is supposed to be all about?

There's a twofold responsibility there. You have to buy the insurance with an eye to coverage.

Posted by: Derek Copold on April 6, 2006 at 11:27 PM | PERMALINK

And what if I can't afford that the inflated prices demanded by for-profit insurance scams? Out in the cold I guess.

Posted by: Toner Cart. on April 6, 2006 at 11:34 PM | PERMALINK

There's a twofold responsibility there. You have to buy the insurance with an eye to coverage.

Posted by: Derek Copold on April 6, 2006 at 11:27 PM

Of all the stupid strawmen in this thread so far, that is one of the stupidest or most dishonest. In many areas of the country, insurers have priced individual policies out of reach of any. So as a practical matter, you are limited to the choices, if any, offered by your employer.

In the areas where you can still get affordable individual policies, you can generally do so only so long as you are young and healthy. The moment you come down with any kind of chronic condition, your rates will go through the roof.

Posted by: tanj on April 6, 2006 at 11:36 PM | PERMALINK

You have to buy your sumptious cakes with an eye to choosing the most delicious frosting.

Posted by: Marie Antoinette on April 6, 2006 at 11:39 PM | PERMALINK

Derek Copold: And one of the things about the U.S. is that our government programs have a nasty tendency of growing and growing. This is a documented fact .... With our system, you still have some incentive to lower costs, and you still have some latitude.

Again, I really don't mean to offend you, I really don't, but this is silly. There is no documented fact that all government programs will grow unjustifiably or that magic private industry "incentives" will lower cost. This is simply not true, either here or in any other country (and I've lived in several). Government programs may grow because the population grows or services are added, and they may also grow because of corruption, mismanagement, etc. There's really no rule. It all depends on who's managing them.

And this business of "incentives" assumes that all private firms are uber-rational. They are not. I've worked for, and with, several large and small corporations and they are as rational as the people who are managing.

Human institutions are fallible. Governments, as well as businesses. There's nothing magical about private enterprise that removes it from the realm of human fallibility.

When we're talking about goods and services with very low elasticity, the best way to allocate them is to do it evenly and private enterprise cannot do that since it has to sell at the highest possible price and with the lowest possible cost -- it is only natural in our system for insurance companies to try to charge as much as possible for the cheapest possible care. If you want to talk "incentives," these are the ones that govern our system.

Posted by: Aris on April 6, 2006 at 11:41 PM | PERMALINK

The implied lie is that all government programs will eventually resemble programs under Soviet bureucracy.

You're erecting a strawman and covering your tracks with the word implied. I never mentioned anything about Soviet bureacracy. I have cited other U.S. bureacracies, though.

The U.S. system is set up so that it's easy to block change. Now that has its advantages, since it makes for a stable set of laws, but it also has it problems, as it's tough to respond to crises, as I'm sure you guys have noted before. So, once you set something in motion, it deuce difficult to stop it. That's why our bureacracies tend to double in size and cost every several years or so.

More centrally directed governments don't have this problem, and they can catch and control costs far more easily. They can make single-payer systems work--though not as well as so many would like to believe.

With the U.S. system, though, once it gets rolling, it's gone, and it's harder than hell getting a grip on it, or steer it, because there will always be interests of one party or another to block any reform. That's why I'm rather shy about turning over 14-15% of the GDP to the government. First, I have no idea where they're going to take it, and I'm not sure if that's going to be right road for us 5, 10 or 20 years down the road. And if it isn't the right road, we have very little chance of steering ourselves onto that road.

This doesn't preclude any reform or program, but it should make us very, very cautious about whatever program we put in place, and we should be looking to push as much of the choice AND cost as close to the primary user as is possible.

Posted by: Derek Copold on April 6, 2006 at 11:43 PM | PERMALINK

I'm a Briton, whose family and own self (and friends, relations and acquaintances, as far as I can remember) have had excellent service from the NHS.

It seems to me that the shorter message of those opposed to any system that resembles any of the systems operating in the other top 20 industrialised nations is

"We can't trust the US federal Govt to run a rational cost-effective system so we should just carry on with the insanely irrational,costly,arbitrary and bizarre system we currently have".

I also like the cherry picking of health and healthcare statistics from whichever of the other 20 industrialised nations provides the barest support for one's "argument", shorn of any actual context.

I haven't seen too blatant an example yet in these
comments, but it's inevitable...

Posted by: Alan on April 6, 2006 at 11:44 PM | PERMALINK

Wish this could have all been on one healthcare item.

DC, among all the crap you spout let's pick on the private side of medicine. Health insurance has far exceeded inflation for the last 17 years (and before that too), except when the Clinton healthcare proposal was in the wind. Insurance cost inflation took a dive around '96, to avoid adverse publicity, but soon recovered as did provider profits. Insurance health care has continued to outpace all the other Western countries in both overall costs and administration. Not only do we spend way more per capita in health care but proportionately even more on administration costs, and those average costs are brought down by our public sector.

What do we get for this. Judged on various stats (yes, these things have already been studied and other nations regularly look at each others systems for ideas, xenophobia not being quite as rampant there), like infant mortality, longevity, outcomes, etc, etc., we rank 20th to 27th or so in the world; no where near the top. And in none of the other Western nations can your health bankrupt you.

I know I'm boring, but you repubby flakes keep trying to treat a non-market as a market, solveable by basic market forces. IT WON"T WORK. It doesn't work. Make the imaginative jump. It won't hurt!

Disclaimer: I am not a doctor, I don't do much at home, I try not to be dangerous to anyones health. Use the US census, Kaiser and OECD among plenty of other sources to check you pulse.

Posted by: notthere on April 6, 2006 at 11:50 PM | PERMALINK

There is no documented fact that all government programs will grow unjustifiably or that magic private industry "incentives" will lower cost.

Not all government programs, maybe, but the record shows that most do grow and keep growing. As for private incentives, if they don't lower costs, why is France using them to lower health costs?

And this business of "incentives" assumes that all private firms are uber-rational.

No, that's not what it assumes. It assumes that there is a market logic. If there is a profit to be made, people will come along to supply the goods that will get that profit. The irrational ones--such as the firms you mentioned--will eventually reform or get weeded out. This has been borne out by history.

The problem with a government payer is that there is no incentive to save costs for the individual. So, he'll use the system to its fullest, even if he doesn't need to. Why not? It's "free." Gotta cold? Go see the doctor. Pull a muscle. See the doctor. When 300 million people do this, the costs tend to go up, a lot. So the government either spends a gozillion dollars, or it clamps down and rations care. Either way, the incentive to lower costs is gone. Either you can charge the gov't up the ying-yang, or under rationing, you provide as little as possible for the fixed price, which the consumer has to accept.

When we're talking about goods and services with very low elasticity, the best way to allocate them is to do it evenly...

In other words, you're going to ration. You're going to tell someone: "You can't have this treatment." I'll tell you right now, there will be hard case stories about this, too. And everyone will demanding yet another round of spending for this, too.

...it is only natural in our system for insurance companies to try to charge as much as possible for the cheapest possible care.

Of course, but the response is to shop around. Unfortunately, we've built up such a static system, with a mess of rules and regs on insurance companies, that this system has ossified. For example, rates are equalized, so the healthy have little incentive to share the risk, and they withdraw. A lot of the uninsured are in this class of people.

As I said before, I really don't have a silver bullet for this

Posted by: Derek Copold on April 6, 2006 at 11:57 PM | PERMALINK

OK, here's a take on the Massachusetts bill by a progressive Sacramento political organizer and Teachers' Union worker:

http://bayneofblog.blogspot.com/2006/04/sham-massachusetts-health-care-bill.html

and he links to a guy who explains the latest on California's single-payer healthcare bill - SB 840:

http://www.californiaprogressreport.com/2006/04/health_insuranc.html

I just can't keep my attention on the nitty-gritty details but Jesus, why can't we have single-payer? Besides corporate greed? Because the system is so bureaucratic, wasteful and cruel right now that it might as well be Communist Russia, with a few oligarchs making out like bandits.

Do you know what the president of an HMO makes in a year? 5 years ago it was $15 million for the guy running my old HMO. Per year. God knows what it is today.

Posted by: Leila on April 6, 2006 at 11:57 PM | PERMALINK

Derek: Read Carroll Quigley's _Evolution of Civilizations_. Pay particular attention to the passages about the institutionalization of social instruments. You'll be glad you did.

Posted by: Toner Cart. on April 6, 2006 at 11:59 PM | PERMALINK

Derek Copold: You're erecting a strawman and covering your tracks with the word implied. I never mentioned anything about Soviet bureacracy. I have cited other U.S. bureacracies, though.

No, you did not mention anything about Soviet bureacracy, and if you don't think that all government programs will unavoidably end up resembling programs under Soviet bureaucracy, then I stand happily corrected... In any case, it doesn't matter. The bottom line is that I don't think there's a system that's worse that ours, and by any objective and subjective criterion many other countries have better, more efficient and cheaper systems.

Goodnight...

Posted by: Aris on April 7, 2006 at 12:01 AM | PERMALINK

Insurance cost inflation took a dive around '96, to avoid adverse publicity, but soon recovered as did provider profits.

In 1996, Clinton care had been shot down for two years and the House and Senate were in GOP hands.

I know I'm boring...

And how. You're not even stating my position correctly. I have never claimed perfection for the system we have, and I acknowledge that there are problems. However, I don't see a single-payer system as the answer.

Posted by: Derek Copold on April 7, 2006 at 12:03 AM | PERMALINK

Of all the stupid strawmen in this thread so far, that is one of the stupidest or most dishonest.

Go look up the meaning of the word strawman. The poster asked about what insurance was theoretically supposed to do, and I pointed out that there are two sides to the story.

In many areas of the country, insurers have priced individual policies out of reach of any. So as a practical matter, you are limited to the choices, if any, offered by your employer.

Again, I am not saying our system is perfect. It has a number of problems. I am not opposed to aiding those in need, nor am I against some kind of program to deal with catastrophic emergency conditions.

However, I'm not comfortable with turning over a large portion of our economy--not to mention our very health--to the U.S. government.

Posted by: Derek Copold on April 7, 2006 at 12:09 AM | PERMALINK

The US healthcare system doesn't work. I want to have a resonable amount deducted from my paycheck in the form of taxes and be able to walk into any doctor's office or hospital, give them my Social Security number, and get what I need to get done, done.

Posted by: grape_crush on April 6, 2006 at 11:12 PM | PERMALINK

Hey, and I want a house on the beach within 15 minutes of the financial sector and a 48 month bonus. I ain't getting it.

Posted by: McA on April 7, 2006 at 12:10 AM | PERMALINK

Might also add, in UK system, NHS and private medicine run side by side. Anyone who can afford it can buy supplemantal insurance. It doesn't have to be the complete end of the world as we know it.

It's really interesting that it's the right-sided capitalists that have so little trust in improving on a system that demonstrably works better in foreign economies than our "system" here.

Posted by: notthere on April 7, 2006 at 12:10 AM | PERMALINK

McA: a house on the beach within 15 minutes of the financial sector and a 48 month bonus. I ain't getting it.

You're clearly in the underclass. I have no problem there.

Posted by: Pretentius on April 7, 2006 at 12:14 AM | PERMALINK

The problem with a government payer is that there is no incentive to save costs for the individual. So, he'll use the system to its fullest, even if he doesn't need to. Why not? It's "free." Gotta cold? Go see the doctor. Pull a muscle. See the doctor.

Hey, you fucking troll, how the fuck do you know it's just a cold or just a pulled muscle BEFORE you go to the doctor? You don't, you shithead. You could have somehting serious and die under our fucked up system which you unthinkingcally defend. What an asshole! The whole point here is to have ACCESS before you fucking croak from somethign undiagnozed and untreated because you couldn't AFFORD insurance or your carrier wouldn't pay for treatment.

If you want to really control costs, and that's your paramount incentive, then how about NOBODY goes to the doctor, period. Cheaper to bury the bodies. Asshole!

Posted by: Themis on April 7, 2006 at 12:24 AM | PERMALINK

Hey, and I want a house on the beach within 15 minutes of the financial sector and a 48 month bonus. I ain't getting it.

How the fuck is a house on the beach in any way comparable to life-saving medicine? Did someone drop you when you were a kid? Asshole!

Posted by: Themis on April 7, 2006 at 12:26 AM | PERMALINK

The U.S. spends more than 10% of GNP on health care. The socialist systems of most European countries are able to provide similar services to a much broader spectrum of their population for less than 5% of GNP. In short, we spend over 600 billion more on health care than we probably need to.

Thus, any argument that attempts to show a priori that socialized health will invariably tend toward waste and bureaucratic mismanagemet must confront the dual reality of a) the waste and mismanagement that already pervades our market based system, and b) the reality of the efficiency of the socialist systems which have proven to be much more effective (in terms of treatment and cost) over time.

Another glaring case of reality based criticism vs. ideological fear-mongering.



Posted by: smedleybutler on April 7, 2006 at 12:29 AM | PERMALINK

Some good comments, Derek. Been there, done that.

There is no documented fact that all government programs will grow unjustifiably.

To the best of my knowledge, for major Federal programs, there is no documented exception, especially when compared to projections at the program's start. I'm open to correction.

--Apple-to-apple comparison of our health care system with those of nations with a tenth of our population and size tend to remind me of comparisons of automobile use between the U.S. and France. I read much of the paper Kevin linked to. I would say the jury is still out on France's system, since they made a major correction on it only ten years ago, and the paper is almost six years old itself.

--The Tribune company that employs Simers offers a range of health benefits, from PPO down to local HMOs. You pick the one you want to pay for.


koreyel:

I mean really... you people still lead the Western world in Syphilis.

Hey, they didn't call it "The American Disease."

Posted by: tbrosz on April 7, 2006 at 12:34 AM | PERMALINK

I understand the corporate role in the problem. I never said they were angels. But with them, I have something of a choice between evils, and that's some leverage, though not a lot.

Choice?? Fucking CHOICE?? What is this, a magic keyword they teach you at troll school? Who the fuck has any choice now, you shihead? Here's my true story:

A few months ago I got an abnormal PAP smear. NO FUCKING INSURANCE COMPANY WOULD INSURE ME!! None. NO FUCKING CHOICE! I checked and ohio has open enrollment periods so I thought I was saved. Someone would have to insure me. It was $3,000 a month! FUCKING CHOICE?? What FUCKING CHOICE, asshole? I remain uninsured despite the fact that i work and i am healthy. I have to wait for a year, have another PAP and if it's clean, I can apply again.

This is the worst of all worlds. I have no insurance, I can get no insurance, and if soemthing's seriously wrong I'm going to fucking die. The system is so fucked up, and then these trolls come in and have the audacity to throw out the word "choice." Choice? Fucking asshole!

Posted by: Themis on April 7, 2006 at 12:35 AM | PERMALINK

Themis: comparable to life-saving medicine

We're talking about the lives subnormals, vs. the comfort of the deserving. Should I give up my weekends in the Hamptons so some peon I've never met doesn't have to suffer? Where's the justice in that? You little people make me sick.

Posted by: Pretentius on April 7, 2006 at 12:36 AM | PERMALINK

McA on April 7, 2006 at 12:10 AM:

I ain't getting it.

Try bathing more frequently...And try to be less of a cretin; your wife will appreciate it.

Nothing in my list of wants is undoabale; Every other modern, industrialized country has something similar. A single-payer, universal US health care system is not going to be simple, and it will have problems.

But, to borrow and paraphrase someone else's words, we Americans don't do things because they are easy, we do them because they are hard...And because they are the right things to do.

Something, with all your talk of God-given morality, refuse to grasp, McA.

Posted by: grape_crush on April 7, 2006 at 12:39 AM | PERMALINK

This never happens at Kaiser. You get in within 2 days, tops, or can go to emergency if you are willing to pay the (increasing) co-pay. And the doctor can treat you without asking anyone's permission. Really, a not-for-profit HMO is fine. It is the profit part that screws it up.

Posted by: Mimikatz on April 7, 2006 at 12:39 AM | PERMALINK

'Derek' posted:

"importing the French system here would probably bankrupt us, or force us to go to rationing."

No, it would cost LESS, as there's no bloated price-gouging insurance industry taking more than half of your health insurance premiums for something other than medical care.
.

Posted by: VJ on April 7, 2006 at 12:42 AM | PERMALINK

In other words, you're going to ration. You're going to tell someone: "You can't have this treatment." I'll tell you right now, there will be hard case stories about this, too. And everyone will demanding yet another round of spending for this, too.

Are you fucking insane? Are you fucking stupid? There are fucking MILLIONS now that cannnot have this or that LIFE-SAVING treatment because they can't afford to. And you have the audacity to talk about RATIONING? You're the fucking assholes, the con-trolls and libertarian trolls, who are making sure you're rationing health care based on who can afford to live and who dies. Asshole! Fucking rationing, no-choice asshole!

Posted by: Themis on April 7, 2006 at 12:45 AM | PERMALINK

Of course I meant to say earlier "the lives of subnormals".

VJ: There are those of us who depend on our investments in the insurance industry. You would deprive us of that. We'd then be little better off than you. No thank you.

Posted by: Pretentius on April 7, 2006 at 12:47 AM | PERMALINK

So, he'll use the system to its fullest, even if he doesn't need to. Why not? It's "free." Gotta cold? Go see the doctor. Pull a muscle. See the doctor.

Yeah, because sitting in a waiting room surrounded by sick people for forty minutes is so much fun, followed by another twenty-plus minutes isolated in a somewhat less germy (but free of any reading material but golf magazines & testicular exam instruction cards) exam room before the doctor comes in for his six and a half minute consult.

On the plus side, national health care might at least get rid of most of the army of snippy billing & insurance clerks that compound the usual med-office indignities, so it might be slightly less unpleasant to see a doctor than it is now. Still not a pleasant event... I have an appointment tomorrow & got stuck with the last slot of the day, meaning the entire day's delays stacked up plus awful Friday-afternoon traffic going home. Yay.

Posted by: latts on April 7, 2006 at 12:56 AM | PERMALINK

I am an American with a single-payer health system. Of course, I had to spend more than 20 years in the Army to get it. When I was younger, and wondering whether or not I should make it a career, I quite frankly did not perceive health care as being a tie-breaker in the decision process. Of course, we're all strong and healthy in our 30s and 40s, with military personnel being in the forefront. Now that the body is starting to bark back, I believe I made a good decision. Not only do I get a decent check each month, I'm insulated from catastrophic costs.

The health care I receive is no worse than what others gets and better than most. I know this because my wife just retired from her job as a nurse with a leading HMO. As her spouse, I had full coverage, but after trying them a couple of times, I decided to stay with the military side. And lot of folks are surprised when I tell them where I get the really good healthcare: top notch physicans, attentive workers, etc. The U.S. Veterans Administration.

Anyone who tells you government health care systems can't work is either an ideological fool or a liar. We can't do anything about liars, but the ideological fools are a true American phenomenon. These people are not rich assholes. They are oftentimes good, decent people holding good, decent middle class jobs. They are not plutocrats and in fact often do not even have a college degree. I often run into these people; they are always surprised that, I a retired military officer, trend further left than they do. I don't have the heart to tell them that the key discriminators between them and me may be that I instinctively distrust all politicians, do not hate any particular group and certainly do not live my life on an ideological basis.

I never cease to be amazed at how normal working stiffs somehow identify with the Bushes, Reagans and Kennedys.

Posted by: Nixon Did It on April 7, 2006 at 1:05 AM | PERMALINK

Latts: I find your complaints irritating.

As a member of the ruling class, I consider our regime to be, by and large, moderate. The able and willing can advance themselves. The indolent and unfortunate will languish. It has always been thus.

The whining of people here about their inability to provide for themselves and their families moves me not at all. You have been improvident, and you suffer the consequences.

It's pathetic really. The deserving prosper. The masses despair. Through all human history that has been the case. Why should things be different now?

Posted by: Pretentius on April 7, 2006 at 1:07 AM | PERMALINK

Yeah, I ran into that abnormal-Pap-smear-ok-we-cleared-it-up-but-you-still-can't-buy-insurance-for-another-year. Bloody bastards.

Where health insurance falls completely down is: what do you do about people on the verge of or who have chronic conditions?

Considering the increasing number of people who have diabetes and who can't get insurance, (Blue Cross/Blue Shield won't allow you to get it) I predict the pressure on the politicians to actually come up with something reasonable will reach a breaking point soon.

Posted by: tzs on April 7, 2006 at 1:10 AM | PERMALINK

My suspicion is that, even if it were hypothetically possible to design a federal single-payer system which by some magic covered every single American, with utterly topnotch care, for a tenth of the cost of today's bungled model, the proposal would fail nevertheless.

And here's why. The Republican Party would stand up and say to their base, in one voice, "Psssst. Hey, buddy. Sounds like a great deal, doesn't it? You like the idea, don't you? Well, here's the kicker. You would get great care under this system. But niggers and fags would get it too."

Which would instantly collapse any chance of acceptance which the scheme might have enjoyed.

I think that collective solutions work better in countries which don't have subpopulations of the polity who viscerally loathe one another. Here, folks really do believe in "beggar-thy-neighbor" as a policy model. Especially if the neighbor is a bugger.

Posted by: marquer on April 7, 2006 at 1:15 AM | PERMALINK

I think that collective solutions work better in countries which don't have subpopulations of the polity who viscerally loathe one another.

You might want to take a closer look at France.

Posted by: tbrosz on April 7, 2006 at 1:23 AM | PERMALINK

It's a great insurance system if you don't have to insure the higher risks or the pre-existing conditions, even if the condition first arose when you had insurance...for the insurers.

Health insurance costs 3 times faster than wages and salaries 1980-92. '92-98 wages and salaries rose faster than insurance costs. That's the BLS talking. 2001 9+%, '02 14.7%, then it starts tailing down to 6.1% in '05 (still almost twice as fast as inflation or wages). Why the decrease in rate of increase? Because insurance companies and employers have moved more of the costs onto users; deductibles, co-pays, declined procedures or coverage. Everybody in the lower half and more has to think twice about going to the doctor. Many don't. Or don't buy the meds.

Health care actually eats 16% of our economy (or there abouts) and still rising. The repubs have been telling us market forces were going to do the trick since the '80s. Yup. Rationing through pricing and faceless bureaucracy.

The richest economy in the world and we don't even look after our children let alone the vulnerable.

Posted by: notthere on April 7, 2006 at 1:37 AM | PERMALINK

tbrosz: We have been watching your posts here and we think you are worthy of advancement. Keep up the good work. Look for "fortune" to smile upon you. We'll get contact information to you through other means. Looking forward to working together.

Posted by: Pretentius on April 7, 2006 at 1:44 AM | PERMALINK

Yay! McA finally shows and...

...Doesn't bring any links.

Where's the proof of the over-defensive medicine?

I've never seen it.

Then again, I've spent the last ten years without insurance or emergency care; and the prior five years on an HMO which refused to really treat me, so I ended up paying for myself.

Grand. I can get the care, sortof, and pay ten times what the HMOs do for the same services.

Posted by: Crissa on April 7, 2006 at 2:02 AM | PERMALINK


You might want to take a closer look at France.

Point taken, although the French system was set up some time ago, when the immigrant Eurabian proportion of the population was considerably smaller relative to the native Gallic population.

It's an interesting question whether the same result would obtain today, were the French trying to design a health scheme _ab initio_.

Posted by: marquer on April 7, 2006 at 2:05 AM | PERMALINK

Socialized medicine is evil, therefore the Amish are evil.

Posted by: la dolce vita on April 7, 2006 at 2:23 AM | PERMALINK

I have insurance for $230 a month, because I original got it through a employer and then was able to keep paying it, never dropping it (and never having the insurance company stop its individual payer plan, which insurance companies can do).

One of my best friends is a little younger and barely less healthy than I am. The *only* insurance she could get is $600 a month- $7,200 a year- with a 20% deductible. One day and night in the hospital and her deductible is more than my yearly insurance cost.

She lost her previous insurance through a combination of moving across the country and her new employer stopping their plan entirely.

Right now, the most unhealthy part of her life is the stress she gets from trying to pay for her insurance each month. $600 is almost as much as her rent.

Posted by: Helen of Troy on April 7, 2006 at 2:30 AM | PERMALINK

If you're insurance doesn't want to cover something, you can pony it up yourself. Under the single-payer system, you often can't do this.

Yes, actually, you can. Single-payer is a form of insurance and has nothing to do with your personal dealings with physicians who will gladly accept a personal check.

Thus we see Canadians coming over here when they need medical care.

No, actually, you don't.

Posted by: Constantine on April 7, 2006 at 2:36 AM | PERMALINK

I kind of like this analogy: health insurance for regular Americans is like malpractice insurance for physicians-- the insurance companies keep squeezing us for more and more money until we realize that it just isn't worth it anymore.

Health insurance is like infrastructure-- I want to get treated, I get treated. It's like the highway system-- I should spend a couple of weeks negotiating with individual highay providers and investigating which highways have a history of problems and which are dependable. I should just get in a car and be assured that the route I'm taking is kept in good condition and gets me there.

Posted by: Constantine on April 7, 2006 at 2:39 AM | PERMALINK

There's someone out there that admits to reading Simers? That's brave.

Posted by: Paul on April 7, 2006 at 3:03 AM | PERMALINK

Well, if you are healthy and poor but not below the poverty line..cough up!

You see rich Canadians coming to the US for healthcare.

Posted by: Mca on April 7, 2006 at 3:09 AM | PERMALINK

Where's the proof of the over-defensive medicine?

Posted by: Crissa on April 7, 2006 at 2:02 AM | PERMALINK

Well, in Kevin's article, the guy waits around for a specialist while in pain. All the GP does is refer, which is not how other medical systems work.

Try the French report. The US system has a really high Specialist to GP ratio.

Posted by: McA on April 7, 2006 at 3:11 AM | PERMALINK

And lot of folks are surprised when I tell them where I get the really good healthcare: top notch physicans, attentive workers, etc. The U.S. Veterans Administration.

Posted by: Nixon Did It on April 7, 2006 at 1:05 AM | PERMALINK

Check out the funding per patient in that system. It ain't free.

Posted by: McA on April 7, 2006 at 3:13 AM | PERMALINK

But, to borrow and paraphrase someone else's words, we Americans don't do things because they are easy, we do them because they are hard...And because they are the right things to do.

Posted by: grape_crush on April 7, 2006 at 12:39 AM | PERMALINK

Like running from spreading democracy in the countries whose dictator's you depend on for oil or used to fight your Cold War?

If Americans get hard things done, its not its Liberal movement that gets it done. Liberals are about 'chickens in every pot' distractions, vote-buying, welfare-subsidizing, community-destroying sleaze politics.

Your strongest support comes from a Black community that has been devastated by a 'blame the government' culture and sabotaged by Democrat support for illegal immigration. Lax law enforcement and the export of liberal secual values have set that community so far back, a refugee from Ethiopia has more chance of making it into middle class.

Your poor have been backstabbed by illegal immigration while your elites are catered for by trying to hold back skilled migration.

Modern liberals are about whining, posturing and blocking positive solutions. Good government in America comes from the interplay between Moderate Dems, RINO's and Conservatives.

Ultra-libs are a dead waste and a distraction, making up for white-guilt while hiding in suburbs or losers who are hooked in their next government handout.


Posted by: McA on April 7, 2006 at 3:21 AM | PERMALINK

Derek said: The problem with a government payer is that there is no incentive to save costs for the individual. So, he'll use the system to its fullest, even if he doesn't need to. Why not? It's "free. Gotta cold? Go see the doctor. Pull a muscle. See the doctor."

Someone else rebutted this upthread, but I would just like to reinforce what they said. Going to the doctor is NOT FUN. You have to take time off from work (and with many employers this means no pay during that time off). You arrive at the doc's office and you wait and wait and wait. You are finally ushered into a too-cold room and perhaps told to remove some or all of your clothing and to put on a gown which covers little more than a postage stamp. The place stinks of isopropyl alcohol and other substances. If you're lucky you won't get a shot or probed in various uncomfortable ways. Most people aren't going to put themselves through this just for the hell of it.

And as the same person pointed out, you don't always know if what seems to be a minor pain or disability won't grow into something far more serious.


"Either you can charge the gov't up the ying-yang, or under rationing, you provide as little as possible for the fixed price, which the consumer has to accept."

Since we are currently spending a good deal more than other industrialized countries with various forms of single payer, why would going to some sort of single payer be more expensive than our current hodgepodge?

In Robert Kuttner's book "Everything for sale : the virtues and limits of markets", he talks about insurance plans and costs. I believe he said that 46% of overhead in private practices goes to keeping up with insurance plans, with their multiple forms and regulations, both of which also change with each year. This was as of 1994 or 1995. I doubt that that figure has gone down.

Here's a URL for an interesting report that just came out today: http://www.cmwf.org/publications/publications_show.htm?doc_id=364436

It's from the patient standpoint and ranks the US versus Australia, Canada, Germany, New Zealand, the United Kingdom. The US ranks highest in effectiveness, third in timeliness, but at the bottom in the other categories rated. Take a look at it if you're interested.

Posted by: Wolfdaughter on April 7, 2006 at 3:28 AM | PERMALINK

Going to the doctor is NOT FUN. You have to take time off from work (and with many employers this means no pay during that time off). You arrive at the doc's office and you wait and wait and wait.

Posted by: Wolfdaughter on April 7, 2006 at 3:28 AM | PERMALINK

Again, assuming you work. Again you are demonstrating the inevitably of queues forming on any free service worth people's time.

If you have universal coverage. Non-workers get covered.

Apparently when Medicare in Australia came in, a few hyperchondriacs who kept claiming they were depressed used up some much money, the Australian system had to regulate its use very tightly.
Such that some genuine depressed people fell out of the system.

Did you realise Universal Healthcare in California would have to include Marijuana prescriptions?

Posted by: McA on April 7, 2006 at 3:39 AM | PERMALINK

Oh, McA!
First you take a strike at someone who actually earned the right to his coverage. He put in the time; it was in the contract. I'll bet he's bright enough to know that nothing comes free, because if he was lucky enough not to have to shove his head into danger, I bet you he knows a few who did, and maybe some blood to save your skinny ass and protect everything you try to whine about in your next blab.

It sure ain't people who simplify everything to a meaningless diatribe and paint everyone with the broadest brush that achieve anything useful. It would be pure accident if you could recognize a problem from a solution.

If you'd make a point worth discussing instead of throwing racial slurs and what I think you believe to be insults but are pure rant.

Try again. Try to be useful.

Posted by: notthere on April 7, 2006 at 3:49 AM | PERMALINK

McA again! Showing no imagination or ability to think on his feet.

Woldaughter: I can't talk about all the national schemes, but many have disincentives for over use. Small co-pays and prescription charges that may vary with ability to pay, or age (e.g. children and retirees).

Doctors are not salesmem so they can choose the most appropriate medicine or treatment--admittedly possibly from a delimited choice. Doctors do not have an incentive to waste resources.

McA can only look at this from a very simplistic market driven angle.

I'll say it again. Health care is a non-market. The trick is to administer it with market-type incentives propeelling it in the right direction. McA won't listen.

Wolfd, on your link, it is good as far as it goes for a basic patient reaction. McA note the bottom line difference and remember they waste far less on administration.

It becomes more dramatic when you include all the other Nordics and such like. And when you start to take outcomes into account.

Yep. Those pesky foreigners not only get health care cheaper. It's actually really, really better. For Everyone. (That's not a concept for McA who has a narrow clan outlook.)

Posted by: Notthere on April 7, 2006 at 4:08 AM | PERMALINK

Wait, its UNIVERSAL coverage. That would mean workers, non-workers people who have never worked - you know people with more queue time.

And I am a non-Nordic foreigner. And I know countries get better health outcomes for free (and tax everyone to pay for it) I'm just not convinced the US could do the same thing.

1. Lawyers suing for percentage of award

2. Advertising drug firms

3. No border controls

4. More expensive doctors and nurses

5. More demands on choice and accidental treatment (which is the expensive bit)

6. Higher homicide rate and nasty accidents from more extreme Sports

7. Fatter, older people than average

8. Higher drug use issues

The list goes on. The fact that Americans make it past 65 regularly is a shock to me.

Posted by: McA on April 7, 2006 at 4:35 AM | PERMALINK

http://www.mexicomedicalvacations.com/

Plus if you are obsessed with foreign health care. Help yourslef.

Posted by: mcA on April 7, 2006 at 4:37 AM | PERMALINK

http://www.singaporemedicine.com/

And here's another.

Posted by: McA on April 7, 2006 at 4:39 AM | PERMALINK

McA, you are such a nut. You just crack me up.

Yeah, thanks for reminding me. So a few rich Canadians drop over here for the best healthcare in the world, or a hip replacement they just can't wait for.

Meanwhile the US is exporting patients. The common citizens are having to scramble around the world to find healthcare they can afford. Nothing wrong with that picture, is there? As long as oil doesn't go through the roof, today Mexico, tomorrow Lagos or Harare or Islamabad to get care that they cannot afford or access within their own country. Christ! The ultimate Repubby solution! And that's assuming US expeditionary governments haven't pissed off everybody in the world! And screw the, by then, what, bottom 55% of the nation who can't afford to fly or buy care.

Your world is a nightmare. It's fascism gone crazy.

Posted by: notthere on April 7, 2006 at 5:15 AM | PERMALINK

If you are really, really loaded. You got to the US because the research is there and the cutting edge Cancer stuff.

But this is the half-million dollar cancer treatment.

Of course, medical tourism is viable. Your base cost of a doctor is his salary and his malpractice insurance. Both are high!

http://www.allied-physicians.com/salary_surveys/physician-salaries.htm

Internists in the National Health Service earn 50,000 pounds. Specialists earn easily 1/2 what the doctors earns. Plus nurses and ancillary support also earn less.

Posted by: mcA on April 7, 2006 at 5:50 AM | PERMALINK

http://www.nhscareers.nhs.uk/nhs-knowledge_base/data/5340.html

Whoops! They only get to 50,000 after a while. They start on 25,000 pounds.

Posted by: McA on April 7, 2006 at 5:53 AM | PERMALINK

McA: You see rich Canadians coming to the US for healthcare.

You lying sack of troll shit! You are a liar. A fucking, boldfaced liar. Rich Canadians DO NOT come to the US for healthcare. That's a lie. Here's the link: http://www.nybooks.com/articles/18802.

You come in at the last minute and try to bamboozle everybody with links to bullshit when you're nothing but a self-hating con who's been convinced by corporations that their interests are the same as your interests and you must defend their right to defraud you at all costs. Idiot!

Posted by: Themis on April 7, 2006 at 7:19 AM | PERMALINK

McA: Apparently when Medicare in Australia came in, a few hyperchondriacs who kept claiming they were depressed used up some much money, the Australian system had to regulate its use very tightly.

You lying sack of troll shit! You are a liar. A fucking, boldfaced liar. Australian hyperchondriacs are not a problem. That's a lie.

Here's the link: http://www.nybooks.com/articles/18802.

Posted by: Themis on April 7, 2006 at 7:22 AM | PERMALINK

McA: And here's another.

You lying sack of troll shit! You are a liar. A fucking, boldfaced liar. That's a lie.

Here's the link: http://www.nybooks.com/articles/18802.

Posted by: Themis on April 7, 2006 at 7:24 AM | PERMALINK

McA: Internists in the National Health Service earn 50,000 pounds. Specialists earn easily 1/2 what the doctors earns. Plus nurses and ancillary support also earn less.

You lying sack of troll shit! You are a liar. A fucking, boldfaced liar. That's a lie.

Here's the link: http://www.nybooks.com/articles/18802.

Posted by: Themis on April 7, 2006 at 7:25 AM | PERMALINK

'Mca' posted:

"You see rich Canadians coming to the US for healthcare."

Actually, the conventional wisdom about Canadians traveling to the U.S. for medical treatment is intentionally misleading:

* Most of those they are counting are Canadians, while utilizing their own healthcare system, who travel a matter of blocks to get an MRI or PET scan at an American medical facility, because of the proximity - they are just across the border, as with Windsor/Detroit, instead of duplicating such machines that would be so close to one another.

* The other category are the "snow birds", those Canadians that live in the Southern U.S. during the Winter, and back in Canada for the rest of the year. If a medical situation arises during the Winter, it would be silly to travel all the way back to Canada.

If these two categories are excluded, and you only look at those people who intentionally set out to travel to another country to obtain medical care, THERE ARE MORE AMERICANS GOING TO CANADA THAN THERE ARE CANADIANS COMING TO THE U.S. It only makes sense given there are some 50 million Americans uninsured.
.

Posted by: VJ on April 7, 2006 at 8:25 AM | PERMALINK

For Kevin Drum -- who is forever economics challenged, an editorial in today's WSJ from Arnold Kling -- reprinted in full cuz you morons are economically challenged and can't afford your own subscriptions.

Bill of Health

By ARNOLD KLING
April 7, 2006; Page A12

The elected leaders of Massachusetts have come up with a novel solution for the vexing problem of paying for health care: abolish the laws of arithmetic. Their new plan is a perfect illustration of what happens when politicians approach a problem unconstrained by reality.

The plan includes tax incentives and penalties for employers and individuals to get everyone covered by a health-care policy. It also promises affordable health insurance for people with modest incomes, under a program yet to be negotiated between the state and private insurance companies. Nevertheless, three numbers stand out: $295, the annual penalty per worker a company must pay to the state if it does not provide health insurance; $0, the deductible on the typical state-subsidized health-insurance policy under the plan; and $6,000, the average annual expenditure on health care for a Massachusetts resident. Each of these numbers represents one of the irreconcilable goals of health-care policy:

$295 represents the goal of affordability. We would like to be able to purchase health-care coverage for $295 a year. If that's what it actually cost, my guess is that the problem of the uninsured would pretty much disappear.

$0 represents the goal of insulation. As individuals, we would like to be insulated from health-care costs. That is why, instead of real insurance -- which would have us pay for at least the first $10,000 of health care out of pocket -- most of us have health-care policies with much lower deductibles.

$6,000 represents the goal of accessibility. We want access to the best care that modern medicine can provide, whatever the expense.

The question is this: What insurance company will provide coverage with $0 deductible, at an annual premium of $295, for someone whose health care costs on average $6,000 a year? The numbers imply losses of over $5,700, not counting administrative costs. To subsidize zero-deductible health insurance, state taxpayers might have to pay out about $6,000 per recipient.

There is no reason to expect firms to rush to offer a policy to uninsured employees. It makes more sense for them to pay their $295 penalty and hand the health-insurance problem back to the individual -- and ultimately to the taxpayers of Massachusetts. Economically, consumers who face deductibles of $0 have no incentive to restrain health-care spending. They are only constrained by the time and discomfort involved in obtaining medical care.

If more Massachusetts consumers enjoy coverage without any deductible, then the average per-person expenditure on health care of $6,000 seems likely to go up. Health insurance companies will not write policies that lose them money. Policies with deductibles of $0 in a state where spending per person on health care is on average $6,000 a year will have very high annual premiums -- presumably over $6,000 a year.

The Massachusetts health plan promises to provide health-insurance companies with subsidies in order to induce them to offer these low-deductible insurance plans. The arithmetic suggests that these subsidies will have to be large -- thousands of dollars larger than the $295 per worker that the state plans to collect from employers that do not provide health insurance.

The problem of paying for health-care coverage, which politicians are declaring they have "solved," is really just beginning. The only way to make zero-deductible health insurance available at low cost is with a large subsidy; how much will depend on negotiations with insurance companies. Only when the size of the necessary tax increase becomes clear will Massachusetts's leaders learn the laws of arithmetic.

Mr. Kling, an adjunct scholar with the Cato Institute, is the author of "Crisis of Abundance: Rethinking How We Pay for Health Care," forthcoming from Cato.

Posted by: Norman Rogers on April 7, 2006 at 8:28 AM | PERMALINK

Norman Rogers: an editorial in today's WSJ...

Wow, hold on there Norm, you fucking moron. No need to say anything else. You use an editorial in the WSJ as your "evidence" that WE are economically challenged? Are you fucking insane? Did you fall down, hard, sometime in your life?

Anyone who's awake knows that the WSJ editorial board is made up of nothing more than fascist shills for huge corporations who hate free enterprise, democracy, and everything American and decent. Might as well quote an article by al Qaeda on what direction our foreign policy should take. If you can trust the WSJ, you can trust al Qaeda.

Asshole!

Posted by: Themis on April 7, 2006 at 9:35 AM | PERMALINK

McA, extra-cranky 'cause he's not 'getting it' on April 7, 2006 at 3:21 AM:

Like running from spreading democracy in the countries whose dictator's you depend on for oil or used to fight your Cold War?

Oh shit, that's funny, McA...You come up with this yourself?

"If we don't stop extending our troops all around the world in nation-building missions, then we're going to have a serious problem coming down the road." Dubya, October 3, 2000

See, Dubya was against nation-building before he was for it. Flippity-Flop goes Dubya!

If Americans get hard things done, its not its Liberal movement that gets it done.

Is balancing a budget hard? Who was president last time America had a balanced budget?

Liberals are about...blah, blah, blah.

For every item in that right-wingnut mantra, there's a corresponding worse one that can be used to describe modern conservatism. Besides, like anyone with a half an ounce of sense gives a rat's ass what you tell yourself 'liberals are about'...

Your strongest support comes from a Black community that...

...Liberals marched alongside of on the way to getting the Civil Rights Act of 1964 enacted. Don't they teach any US history out in your southeast Asian neck of the woods?

Your poor have been backstabbed by illegal immigration

Yep, all them damn liberals in charge of companies and corporations sure have screwed the American poor...You'd think that campaign donations by these liberal corporate executives would go to Democratic candidates, not 'publicans...

while your elites are catered for by trying to hold back skilled migration.

Aww...Your green card application get denied, McA? Perhaps no one thought you possess any skills...I certainly don't; other than lying, that is...And there are plenty of 'publicans already here in the US that do a superb job at lying.

The rest of your post is just more lies that you lie to tell yourself. As a Christian, with God-given moral guidance, how do you reconcile your lying and inegalitarian positions with your faith?

It seems like you need to re-examine your dedication to the example Jesus provided.

Posted by: grape_crush on April 7, 2006 at 9:38 AM | PERMALINK

Themis on April 7, 2006 at 9:35 AM:

Wow, hold on there Norm..Are you fucking insane? Did you fall down, hard, sometime in your life?

While that may or may not be true, the editorial has it right; the numbers don't add up...Had that figured out yesterday.

I've done a little research on my own, including reading the Cato position on the Massachusetts health initiative posted on the Cato site...Aside from this whole math thingy, they get the reasons wrong and the conclusion right. Heritage, OTOH...(shudders)...

You're right about the WSJ editorial pages; it usually is like reading a corporate boardroom circle-jerk.

Posted by: grape_crush on April 7, 2006 at 9:54 AM | PERMALINK

Wait time for Mom's cancer surgery; 1 week from diagnosis.

Wait time for sister-in-law's broken knee...24 hours. (took them 3 hours to get her off the ski-hill). She was given the option of travelling home to Manitoba and having the surgery in 5 days, or having it in Alberta immediately.

Total out of medical bills sent to these patients...$0.00.

Evil socialist medicine, I tell you. Pure evil...

Posted by: A Hermit on April 7, 2006 at 10:01 AM | PERMALINK

With the U.S. system, though, once it gets rolling, it's gone, and it's harder than hell getting a grip on it, or steer it, because there will always be interests of one party or another to block any reform. That's why I'm rather shy about turning over 14-15% of the GDP to the government.

The claim that the government, if put in charge of health care would spiral out of control is simply not backed up in the real world. Thge federally-run Medicare has a 2-3% administrative overhead, as does the federally-run Veterans Administration, while Medicaid has 6-7%. Compare this to commercial insurance administrative overhead, which tends to be much higher 10-30%.

In the United States, therefore, it's private enterprise which is bloated and ineffective, while the federal system is a model of streamlined efficiency.

All these arguments that we can't allow the government to take over healthcare because it will run out of control are essentially saying that if we let the government run it, it may perhaps one day produce a system that as bizarre, bureacratic, costly and insane as the one we already have now ....

Posted by: Stefan on April 7, 2006 at 10:24 AM | PERMALINK

The bottom line is that I don't think there's a system that's worse that ours,

Afghanistan? Somalia? Iraq?....

Then again, all those countries are free-market paradises....

Posted by: Stefan on April 7, 2006 at 10:28 AM | PERMALINK

Thus, any argument that attempts to show a priori that socialized health will invariably tend toward waste and bureaucratic mismanagemet must confront the dual reality of a) the waste and mismanagement that already pervades our market based system, and b) the reality of the efficiency of the socialist systems which have proven to be much more effective (in terms of treatment and cost) over time.

Actually, any argument that attempts to show a priori that socialized health care will inevitably tend toward waste and bureacratic mismanagement must simply ignore these dual realities. Why attempt to confront the facts when you can simply deny their existence? So much easier to live in the wild-eyed Randian fantasy world than actually having to deal with reality.

Posted by: Stefan on April 7, 2006 at 10:37 AM | PERMALINK

Well, screwed up those tags. Sorry for all the shouting....

Posted by: Stefan on April 7, 2006 at 10:39 AM | PERMALINK

Geez, the grass is always greener isn't it?

Here is my true story - non-HMO - great medical center.

I hurt my knee playing ball and knew it was seriously wrong.

I went to urgent - care, which is better than an ER. They immediately sent me downstairs for an X-ray before even seeing a Dr.

X-ray was fast and about an hour later I'm seeing a Dr. The x-ray was already read, he saw the results on his terminal, and my knee was not broken. Go home, come back in a week.

A week later it doesn't hurt, per se, but I can't totally straighten my knee. I'm limping around.

Refered to specialist. A week later he sees me and schedules MRI. A week later I have MRI and the results show torn cartilage, bent into the knee.

We schedule surgery - two weeks later. Scope surgery is fine, I'm walking the same day and I'm totally recovered.

So start to finish took maybe 6 weeks, and this was under a non-HMO. I was totally satisfied with the time it took to get surgery. After the initial diagnosis I knew I had a fairly annoying injury that wouldn't heal on its own, but how could I justify anything like emergency surgery or jumping the line ahead of anyone else?

I'm sure if this was an HMO somebody would be using me as a scare story about rationing or delays but really everything they did made sense. It made sense that I wait for more urgent cases.

Posted by: Tripp on April 7, 2006 at 11:16 AM | PERMALINK

I had almost the exact opposite experience as this sportswriter:

When I hurt my knee playing soccer last year, I was certain it was an ACL tear (I'd had one before--it's hard to miss). I went to a knee specialist (an expert who is currently a head team doctor for a professional sports team) who confirmed this, not by MRI but by testing the stability of the joint through a series of tests. We scheduled surgery. The morning of the surgery, as I was fasting and fighting the pre-surgery butterfles my doctor calls and says he can't do the surgery: a person from the insurance company, with no medical experience flagged my claim and said the doctor couldn't perform the surgery until the diagnosis was confirmed with one of those enormously expensive MRI exams. The doctor was livid-they had essentially questioned his diagnosis and in the process inconvenienced everyone while adding a huge MRI bill on top of it. Needless to say, the test confirmed what the doctor and I, both who had a hell of a lot more experience with ACL tears than the insurance agent, feared. Surgery was rescheduled and now I'm going through rehab.

I'm not sure what the moral of the story is here, except that there is huge inefficiency and wastefulness in this system already.

Posted by: Joe on April 7, 2006 at 11:22 AM | PERMALINK

Stefan,
"The claim that the government, if put in charge of health care would spiral out of control is simply not backed up in the real world. "

[guffaws of laughter]. It it is backed up by decades of experience with existing federal entitlement programs, which have consistently ended up costing vastly more than their proponents claimed they would, and which consume every-increasing shares of government spending. The Medicare prescription drug plan is the latest example. Furthermore, health care costs in countries with government-funded health care have in recent years been increasing faster than health care costs in the U.S. Your claim about "administrative costs" is irrelevant even if it's true, since those costs are just a small fraction of total health care costs.

Government-run health care would combine the cost-efficiency of the Defense Department with the compassion of the IRS.

Posted by: jibjab on April 7, 2006 at 12:40 PM | PERMALINK

I sometimes see the argument being made that publicly funded, universal healthcare would take away your freedom to choose your Doctor and make decisions about your treatment.

I think Joe's story illustrates that it's the private insurance companies which take away that freedom. Sure doesn't woork that way here in Soviet Canuckistan...

Posted by: A Hermit on April 7, 2006 at 12:45 PM | PERMALINK

"health care costs in countries with government-funded health care have in recent years been increasing faster than health care costs in the U.S."

Funny thing though, jibjab; per capita public health care expenditures (that's tax dollars spent by governments) are actually LOWER in countries with single payer public systems than they are in the US. Your allegedly private system costs taxpayers more than the "socialist" systems in Canada, France, Sweden...hell the rest of the industrialized world.

Add in the vastly higher amounts from private sources (eg businesses paying for their employees) and health care costs per capita in the US are almost twice what they are in Canada.

Now consider that in the public model everyone is covered, while the private insurance model in the US leaves about 12% of the population with no coverage at all.

So, you pay more, get less for it, but you want me to believe your way is more efficient? Why? Because the magic market fairies say so?

Posted by: A Hermit on April 7, 2006 at 12:54 PM | PERMALINK

Hermit,

"Funny thing though, jibjab; per capita public health care expenditures (that's tax dollars spent by governments) are actually LOWER in countries with single payer public systems than they are in the US."

Other countries spend less because they provide lousy health care. In Britain and Canada people have to wait months or years to see a specialist or to get surgery that Americans get right away.

But you missed the point, anyway, which is that health care costs in government-run systems are rising faster than they are in the U.S. You apparently want our health care costs to start rising faster also.

"Now consider that in the public model everyone is covered, while the private insurance model in the US leaves about 12% of the population with no coverage at all."

Also false. The uninsured in the U.S. receive health care from a variety of sources, and most periods of uninsurance are temporary, typically a few months. Under government-run health care, services are strictly rationed, hence the long waiting lines for procedures Americans take for granted, and the denial of important, even life-saving, services to people who fail to meet the government's cost-benefit standards.

Posted by: jibjab on April 7, 2006 at 1:26 PM | PERMALINK

Other countries spend less because they provide lousy health care.

Flatly untrue. By most independent standards the US provides worse care than most other industrialized countries. The World Health Organization ranks the US 37th in the world in quality of care, even though we pay twice as much as anyone else.

In Britain and Canada people have to wait months or years to see a specialist or to get surgery that Americans get right away.

That's completely true, when I was uninsured and working for myself I saw a specialist right away!

Oh, wait, no, I didn't. I couldn't afford to see one, so I never did, and suffered for several years until I got insurance.

and most periods of uninsurance are temporary, typically a few months.

While in single-payer countries no one has periods of uninsurance ever. Besides, that "typically" is an average, not a median. There are many people who suffer years of uninsurance.

Under government-run health care, services are strictly rationed,

No, they're not.

hence the long waiting lines for procedures Americans take for granted, and the denial of important, even life-saving, services to people who fail to meet the government's cost-benefit standards.

Which again doesn't seem to square up to the fact that most other industrialized countries outperform us on health care measures.

Posted by: Stefan on April 7, 2006 at 1:50 PM | PERMALINK

"...and the denial of important, even life-saving, services to people who fail to meet the government's cost-benefit standards."

And that doesn't happen here? Especially if the HMO won't pay for your pre-existing condition? How stupid do you think we are?

Posted by: mwg on April 7, 2006 at 1:58 PM | PERMALINK

Stefan,

"By most independent standards the US provides worse care than most other industrialized countries."

Complete and total nonsense. There aren't even any "independent standards" of care.

"The World Health Organization ranks the US 37th in the world in quality of care, even though we pay twice as much as anyone else."

The WHO study you're referring to is considered a joke amoung serious health care professionals. And your claim that it "ranks the US 37th in the world in quality of care" is completely false, anyway. It didn't rank countries by "quality of care" at all. It's obvious that you don't even know what the study purported to be studying.

"Oh, wait, no, I didn't. I couldn't afford to see one, so I never did, and suffered for several years until I got insurance."

Yes, you are perfectly free to choose to go without health insurance and suffer instead if that's what you want.

"While in single-payer countries no one has periods of uninsurance ever. Besides, that "typically" is an average, not a median."

"Single-payer" has nothing to do with the proportion of the population that is insured. And "typically" is not an everage, it's a median. The median length of a period of uninsurance in America is a few months. And uninsured people receive health care services, anyway.

"No, they're not."

Yes, they are. Rationing of health care services is an acute problem in countries with government-run health care.

Posted by: jibjab on April 7, 2006 at 2:11 PM | PERMALINK
Rationing of health care services is an acute problem in countries with government-run health care.

Its certainly one of the more frequently cited areas of dissatisfaction in those systems, which have generally higher satisfaction than the US system.

OTOH, rationing is also one of the most frequently cited areas of dissatisfaction in the US system as well; the US system just uses a different rationing mechanism -- rationing based on costs, insurability, etc.

I think the evidence suggests that the US rationing method is more problematic than those used in most universal coverage countries.

Posted by: cmdicely on April 7, 2006 at 2:15 PM | PERMALINK

mwg,

"And that doesn't happen here? Especially if the HMO won't pay for your pre-existing condition?"

It happens much more in countries with government-run health care. See, for example, this article from a British health economics professor:

"Rationing involves depriving patients of care from which they could benefit and which they wish to consume. The British are much more vigorous than Americans are in "drawing the line," as Henry Aaron, William Schwartz, and Melissa Cox show in Can We Say No? ...

"Then and now the authors show that the British spend less on health care and consequently provide less care for their citizens....

"relative gaps in provision remain large and have increased since the 1984 book. So while the funding of care for patients with chronic renal failure in the NHS has given elderly patients increased access to dialysis, provision in this and other specialist areas remains inferior to that in the United States....

"The authors examine relative provision in a number of other areasincluding hemophilia, stem cell transplantation, hip replacement, cardiac revascularization, and intensive carewhich affect the relative quality and length of life of patients in the two countries. In all of these areas, although the United Kingdom is providing absolutely more care than in 1984, the gap between British frugality and American generosity is widening.

If you want yourself or your loved ones to die early of cancer, heart disease, kidney disease, etc., and to suffer years of chronic pain and disability before that happens because the government denies you health services you need, by all means move to Britain or Canada or some other country with government-run health care.

"How stupid do you think we are?"

Very stupid.

Posted by: jibjab on April 7, 2006 at 2:23 PM | PERMALINK
It happens much more in countries with government-run health care. See, for example, this article from a British health economics professor

Even if this proved the claim you were makign was true of the British system, it hardly establishes any reason to believe it is generally true of government-run systems in countries offering universal coverage; there is a reason why Britain is often pointed to, even by those supporting universal coverage, as among the worst of those kinds of systems rather than an exemplar.

Posted by: cmdicely on April 7, 2006 at 2:26 PM | PERMALINK

cmdicely,

"Even if this proved the claim you were makign was true of the British system, it hardly establishes any reason to believe it is generally true of government-run systems in countries offering universal coverage;"

Of course it does. It illustrates what happens when you put the government in charge of health care.

"there is a reason why Britain is often pointed to, even by those supporting universal coverage, as among the worst of those kinds of systems rather than an exemplar."

Well, make up your mind. I keep seeing claims here to the effect that the British and Canadian health care systems are vastly superior to the American system, claims that are utterly demolished by evidence such as the article I link to above.

Posted by: jibjab on April 7, 2006 at 3:01 PM | PERMALINK

You lying sack of troll shit! You are a liar. A fucking, boldfaced liar. Australian hyperchondriacs are not a problem. That's a lie.

Here's the link: http://www.nybooks.com/articles/18802.

Posted by: Themis on April 7, 2006 at 7:22 AM | PERMALINK

Themis, you are a lying sack of shit. The link has nothing to do with Australia.

Seriously, do you cover therapy for free?

Posted by: McA on April 7, 2006 at 3:05 PM | PERMALINK

THERE ARE MORE AMERICANS GOING TO CANADA THAN THERE ARE CANADIANS COMING TO THE U.S. It only makes sense given there are some 50 million Americans uninsured.

Posted by: VJ on April 7, 2006 at 8:25 AM | PERMALINK

Canada doesn't cover Americans.

Posted by: McA on April 7, 2006 at 3:06 PM | PERMALINK

Except of course that anyone who has experienced UK and US care will tell you flat out - give me UK care.

I've had 5 years experience of both, and I can tell you - US medical is a joke. There is no guarantee I get my doc of choice due to what policies he accepts, and I have to check every referal to see if I need another referal because they aren't in coverage. And my typical wait time to see a general doctor has been abysmal, compared to a british GP.

Give me back the NHS, I'm fucking sick of the shitty US model. And I've have company coverage in both countries - never had to resort to Bupa in the UK, NHS was fine.

Posted by: royalblue_tom on April 7, 2006 at 3:07 PM | PERMALINK
Of course it does. It illustrates what happens when you put the government in charge of health care.

Only if you falsely assume that all government-run healthcare models perform identically, which is idiocy of a high order.

Well, make up your mind.

I haven't been inconsistent.

I keep seeing claims here to the effect that the British and Canadian health care systems are vastly superior to the American system,

I haven't seen anyone claim that, certainly not a lot of claims of that. I have seen some people claim that even the British and Canadian systems are superior to the US system in a number of ways, and cite specific evidence which establishes that. These same people often note that Britain and Canada are far from the best, or even average, among Western industrial democracies with universal systems, and I haven't seen anyone advocate the US should adopt a system along, particularly, the UK NHS model.

Posted by: cmdicely on April 7, 2006 at 3:08 PM | PERMALINK

Hey , starting houseman salary in UK 25,000 pounds. You find doctors to work for that.

You are all unimportant losers.

Bush rules your country now. He is what we all think Americans are.

Posted by: McA on April 7, 2006 at 3:10 PM | PERMALINK

Well obviously they do, or they would pay more - are you stupid or what McA?

Posted by: royalblue_tom on April 7, 2006 at 3:14 PM | PERMALINK

As for the ludicrous WHO World Health Report 2000 that Stefan mentioned, I suggest you read this scathing critique of it that appeared in The Lancet, written by Vincente Navarro, a professor in the School of Public Health at Johns Hopkins. Quote:

"At the top of the WHOs health-care league were countries such as Spain and Italy, whose health-care systems were rarely considered models of efficiency or effectiveness before. In Spain, for example, release of the WHO report, which ranked the Spanish system as the third best in Europe, after Italy and France, coincided with unprecedented demonstrations against the Spanish healthcare authorities. Demonstrators were protesting against the long waiting lists for critical life-and-death interventions (which had been responsible for a large number of deaths) and the short consultation times in primary-care centres (an average of 3 mins per consultation). This state of affairs in the Spanish system had forced prominent professional associations, including the Spanish Association of Primary Care Physicians, to denounce the current situation as intolerable...

"Something seemed profoundly wrong in the reports claiming that the performance of the Spanish system was the seventh best in the world. The reports conclusions certainly did not
coincide with the perceptions of most Spanish people. In one of the most rigorous surveys of views of the Spanish population regarding health care, Spaniards expressed more discontent with their system than did the population of any other major country in the European Union, except Italy, whose health care was also listed among the best in the WHO report. An impressive 28% of the Spanish population (and an even more impressive 40% of the Italian population) indicated there was so much wrong with their HCS (health-care system) that they needed to completely rebuild it, and an additional 49% of the Spanish population (and 46% of the Italian population) stated that there were some good things in their HCS but fundamental changes were needed to make it better."

If the Spanish health care system really is the third-best health care system in Europe, then God save us from European health care.

Posted by: jibjab on April 7, 2006 at 3:14 PM | PERMALINK

Rationing? Haven't heard of any such thing here. People might have to wait for things like hip replacements (for a whole variety of reasons which have nothing to do with funding but often have to do with the privately run medical associations being unwilling to certify more specialists) but it's a level playing field, and even if you do have to wait your place in line is determined by how badly you need treatment, not by the contents of your bank account. What do you call leaving 12-15% of your fellow citizens with no health insurance whatsoever? Isn't that a form of rationing? And isn't it worse to base it on money and not on actual medical need?

According to jibjab: " In Britain and Canada people have to wait months or years to see a specialist or to get surgery that Americans get right away."

Guess you missed my earlier posts, jibjab. I live in Canada, so I hapen to know from personal experience that you're full of shit. My mother had to wait a grand total of one week for her cancer surgery last fall.

More from jibjab: "But you missed the point, anyway, which is that health care costs in government-run systems are rising faster than they are in the U.S."

I'd really like to see your evidence on this point, `cause I suspect you're as poorly informed about costs as you are about quality of care. In fact, I know you are:


Who's Going Broke? Comparing Growth in Healthcare Costs in Ten OECD Countries


"Government healthcare expenditures have been growing much more rapidly than GDP in OECD countries. For example, between 1970 and 2002 these expenditures grew 2.3 times faster than GDP in the U.S., 2.0 times faster than GDP in Germany, and 1.4 times faster than GDP in Japan. How much of government healthcare expenditure growth is due to demographic change and how much is due to increases in benefit levels; i.e., in healthcare expenditures per beneficiary at a given age? This paper answers this question for ten OECD countries -- Australia, Austria, Canada, Germany, Japan, Norway, Spain, Sweden, the UK, and the U.S. Specifically, the paper decomposes the 1970-2002 growth in each countrys healthcare expenditures into growth in benefit levels and changes in demographics. Growth in real benefit levels has been remarkably high and explains the lions share  89 percent  of overall healthcare spending growth in the ten countries. Norway, Spain, and the U.S. recorded the highest annual benefit growth rates. Norways rate averaged 5.04 percent per year. Spain and the U.S. were close behind with rates of 4.63 percent and 4.61 percent, respectively. Allowing benefit levels to continue to grow at historic rates is fraught with danger given the impending retirement of the baby boom generation. In Japan, for example, maintaining its 1970-2002 benefit growth rate of 3.57 percent for the next 40 years and letting benefits grow thereafter only with labor productivity entails present value healthcare expenditures close to 12 percent of the present value of GDP. By comparison, Japans government is now spending only 6.7 percent of Japans current output on healthcare. In the U.S., government healthcare spending now totals 6.6 percent of GDP. But if the U.S. lets benefits grow for the next four decades at past rates, it will end up spending almost 18 percent of its future GDP on healthcare. The difference between the Japanese 12 percent and U.S. 18 percent figures is remarkable given that Japan is already much older than the U.S. and will age more rapidly in the coming decades. Although healthcare spending is growing at unsustainable rates in most, if not all, OECD countries, the U.S. appears least able to control its benefit growth due to the nature of its fee-for-service healthcare payment system. Consequently, the U.S. may well be in the worst long-term fiscal shape of any OECD country even though it is now and will remain very young compared to the majority of its fellow OECD members."


Here is a chart showing relative growth rates. The US isn't doing as badly as Korea or Portugal, but costs are growing faster for you than they are for publicly funded programs like those in Canada or Sweden.

http://www.oecdobserver.org/images//1055.photo.jpg

Actual per-capita expenditures can be seen here:

http://www.oecdobserver.org/images//1256.photo.jpg

Note that the US spends almost twice as much, and is seeing a faster rate of increase in costs, as countries with publicly funded systems.

You need to educate yourself jibjab. Your country is paying way too much for a second rate system, and it's only going to get worse if you don't fix it.

And that affects me, because Canada's economy is so closely ties to yours. I don't want your mistakes to have a negative effect on me. If seniors in your country need cheaper drugs, for example, they shouldn't need to come up here and buy up our stocks. You need to come up with a program that gets them lower prices instead of one that lines the pockets of pharmeceutical companies and private insurers.

Posted by: A Hermit on April 7, 2006 at 3:15 PM | PERMALINK

cmdicely,

"Only if you falsely assume that all government-run healthcare models perform identically, which is idiocy of a high order."

The conclusion requires no such assumption, and your belief that it does demonstrates rank stupidity of monumental propoprtions.

"I haven't been inconsistent."

Yes you have.

Posted by: jibjab on April 7, 2006 at 3:17 PM | PERMALINK

"The conclusion requires no such assumption, and your belief that it does demonstrates rank stupidity of monumental propoprtions."

Posted by: jibjab on April 7, 2006 at 3:17 PM |

I think I've just demonstrated that an assumption is all it is. The real world data all suggest otherwise. What's required here is some evidence, which I have provided above. To maintain your assumptions without offering some evidence to back them up would be "rank stupidity of monumental propoprtions".

Posted by: A Hermit on April 7, 2006 at 3:23 PM | PERMALINK

Of course it does. It illustrates what happens when you put the government in charge of health care.

Actually, it illustrates what happens when you put the British government in charge of health care. Unless everything that happens in Britain has some sort of universal applicability so that it serves as a universal predictive model for the rest of the world.

Posted by: Stefan on April 7, 2006 at 3:25 PM | PERMALINK

Hermit,

"Here is a chart showing relative growth rates. The US isn't doing as badly as Korea or Portugal, but costs are growing faster for you than they are for publicly funded programs like those in Canada or Sweden."

Canada and Sweden's costs are growing more slowly in part because they provide lousy health care. Even cmdicely seems to realize that Canada is a poor role model for a health care system.

As the chart you link to shows, the increase in health care costs between 1990 and 2001 was lower in the U.S. than the OECD average, and lower in the U.S. than in Britain, Ireland, Japan, Portugal, Poland, Norway, Mexico, Korea, Greece, the Czech Republic, Belgium and Australia.

Posted by: jibjab on April 7, 2006 at 3:31 PM | PERMALINK

Except of course that anyone who has experienced UK and US care will tell you flat out - give me UK care.

Oh, god, yes. Actually I prefer the treatment I got in France and in Germany, which in my experience has been hands down the best, but failing that I'd still rather get sick in Britain than in the US -- at least Britain won't bankrupt me.

Posted by: Stefan on April 7, 2006 at 3:38 PM | PERMALINK

Hermit,

"Rationing? Haven't heard of any such thing here. "

I can certainly understand that, given your handle.

"People might have to wait for things like hip replacements (for a whole variety of reasons which have nothing to do with funding but often have to do with the privately run medical associations being unwilling to certify more specialists) but it's a level playing field,"

Utter nonsense. Of course it's not a level playing field. Wealthier Canadians jump the queue by getting treatment in the U.S., or through private care in Canada. Canada actually tried to ban all private health care when it enacted its Medicare system, the only country in the world to do so, but has now finally realized what an utter disaster that policy was.

Posted by: jibjab on April 7, 2006 at 3:39 PM | PERMALINK

Stefan,

If you prefer European health care, by all means move there. According to your beloved WHO report, the Spanish system, which is so bad it provoked public demonstrations against "the long waiting lists for critical life-and-death interventions (which had been responsible for a large number of deaths) and the short consultation times in primary-care centres (an average of 3 mins per consultation)" is the third-best in Europe.

Talk about setting the bar low.

Posted by: jibjab on April 7, 2006 at 3:48 PM | PERMALINK

'McA' posted:

"Canada doesn't cover Americans."

Never claimed they did.

Who would be stupid enough to travel to Canada for medical treatment and then tell them they are an American ?
.

Posted by: VJ on April 7, 2006 at 4:10 PM | PERMALINK

'cmdicely' posted:

"It illustrates what happens when you put the government in charge of health care."

That's a classic Straw Man argument.

NOBODY, certainly not any federally elected official, and NOBODY I've ever heard of in this entire country, has proposed putting "government in charge of health care", as is the case in Britain.

What HAS been proposed, is that the federal government be put in charge of health INSURANCE. The private-sector would still operate medical care.
.

Posted by: VJ on April 7, 2006 at 4:18 PM | PERMALINK

"Canada doesn't cover Americans."

Ever heard of an exchange rate ? I live about 20 minutes from the Canadian border, so trust me when I say that Americans make purchases for all sorts of things in Canada based upon the favorable exchange rate. It's not what it used to be, but there's still enough of a difference that people will drive there instead of shopping here in the US. In addition, we get Canadian commercials here for various products and services on certain broadcast channels. The bottom line is this: if it is going to cost 15% less and you're paying out of pocket, then you're certainly going to make the drive. That, of course, doesn't even begin to cover the prescription drug cost differences.

Posted by: OhNoNotAgain on April 7, 2006 at 4:41 PM | PERMALINK

"As the chart you link to shows, the increase in health care costs between 1990 and 2001 was lower in the U.S. than the OECD average, and lower in the U.S. than in Britain, Ireland, Japan, Portugal, Poland, Norway, Mexico, Korea, Greece, the Czech Republic, Belgium and Australia." jibjab

And higher in the US than in France, Canada, Sweden, etc all of which have a much greater degree of government involvement than the countries doing worse. So your earlier claim that " health care costs in government-run systems are rising faster than they are in the U.S." is clearly false. So thanks for helping make my point.

In fact, if you check I think you'll find the countries that are having the worst problem are often those which have been experimenting with more privatization (Belgium, for example, or Britain, where the problems started with Thatcher), or those which are modernizing old systems left over from Communist regimes or third world tyrannies (Poland, Korea, Mexico, etc). COmpared with any of those countries Canada's system is in great shape, and it is clearly outperforming the private US system.

I see you haven't adressed the fact that US public per capita spending is actually higher than any oteh OECD nation, and private spending almost doubles the total spent in the US. How is this more efficient?

And I'l say it again; you're illusions about the state of health care in Canada are just that; illusions. No system is perfect, but the horror stories you're telling are pure fiction.

One week wait for cancer surgery, jibjab. That's my real life experience. I actually live here, actually use the system, so please don't try to pretend to me that you know what you're talking about it. You clearly don't, and bullshit like this: "Canada actually tried to ban all private health care when it enacted its Medicare system, the only country in the world to do so, but has now finally realized what an utter disaster that policy was." only proves it.

And as VJ points out, you seem to be confusing publicy funded one payer health insurance with being "in charge of health care". Not the same thing.

Face it jibjab, you're a featherweight in a heavyweight fight here; better bulk up on some facts before you rumble with the big boys...

Posted by: A Hermit on April 7, 2006 at 6:07 PM | PERMALINK

Hermit,

"And higher in the US than in France, Canada, Sweden, etc all of which have a much greater degree of government involvement than the countries doing worse. So your earlier claim that " health care costs in government-run systems are rising faster than they are in the U.S." is clearly false."

No, my claim is clearly true. Health care costs have been rising faster in Britain, Ireland, Japan, Portugal, Poland, Norway, Mexico, Korea, Greece, the Czech Republic, Belgium and Australia, all of which have a greater degree of government involvement in health care than the U.S. Britain has one of the greatest levels of government involvement in the world, because the central government controls both all funding and all delivery under the NHS. Health care cost increases in the U.S. have also been less than the average for all OECD countries.

"In fact, if you check I think you'll find the countries that are having the worst problem are often those which have been experimenting with more privatization"

The reason other countries are "experimenting with more privatization" is precisely because their public health care systems have been such spectacular failures, causing massive public pressure for more privatized and market-oriented reforms and alternatives. As I said, Canada originally attempted to ban all private medicine, a supremely dumb piece of public policy that it is now finally abandoning.

"COmpared with any of those countries Canada's system is in great shape, and it is clearly outperforming the private US system."

[guffaws of laughter].

Posted by: jibjab on April 7, 2006 at 6:55 PM | PERMALINK
Health care costs have been rising faster in Britain, Ireland, Japan, Portugal, Poland, Norway, Mexico, Korea, Greece, the Czech Republic, Belgium and Australia, all of which have a greater degree of government involvement in health care than the U.S.

Every OECD country, including the ones occasionally cited as models for a US system (France and Germany) has more government involvement than the US; IIRC, Mexico is the only other country without some form of universal system.

So, your observations that a bunch of countries with universal systems not cited as desirable models by US proponents of univershal healthcare plus one lacking a universal healthcare have faster cost growth (but still, far smaller per capita and per GDP costs) than the US system says absolutely nothing about the desirability of any kind of universal healthcare that would be adopted in the US, judging from either the proposed models or cited examples by proponents.

Again, your argument relies on failing to recognize that differences in type of government health coverage result in substantial differences in performance measures.

Posted by: cmdicely on April 7, 2006 at 7:03 PM | PERMALINK

Hermit,

"One week wait for cancer surgery, jibjab. That's my real life experience. I actually live here, actually use the system, so please don't try to pretend to me that you know what you're talking about it."

From Canada's own Fraser Institute:

"The Fraser Institute's fourteenth annual waiting list survey found that Canada-wide waiting times for surgical and other therapeutic treatments changed very little in 2004. Total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, rose from 17.7 weeks in 2003 to 17.9 weeks in 2004."

Gee, you only have to wait over four months to get specialized treatment in Canada. Tell that to an American woman who has just found a lump in her breast or a man who urgently needs a bypass procedure. What a terrific, efficient, responsive health care system you have up there. And that's just the average wait. For many Canadians, the wait will be much longer.

Posted by: jibjab on April 7, 2006 at 7:05 PM | PERMALINK

cmdicely,

"So, your observations that a bunch of countries with universal systems not cited as desirable models by US proponents of univershal healthcare"

I do wish you would stop claiming to speak for all US proponents of universal health care. You personally may understand that Britain and Canada and other countries with single-payer, "universal converage" health care systems are not desirable models for the US to follow, but other "US proponents of universal health care" keep making claims to the contrary.

What "model" are you proposing? Or is your game just to criticize the US system without offering an alternative?

Posted by: jibjab on April 7, 2006 at 7:13 PM | PERMALINK

Perhaps cmdicely thinks some other European health care system is a "desirable model" for the U.S. to adopt. I've already pointed out some of the disastrous features of Spain's "third-best in Europe" health care system -- lengthy waits for critical, life-saving medical treatment.

Perhaps cmdicely would propose France, which seems to be another favorite of certain liberal nanny-staters. Here is a World Health Organization bulletin on the sorry state of the French health care system. Quote:

"The French public health system once praised by WHO as the best in the world is overburdened, wasteful and in urgent need of an overhaul, says a government-commissioned report released in January. ...

"... the report highlighted several problems. In particular, a projected 10.9 billion (US$ 13.7 billion) shortfall in the public health insurance budget in 2004, which could balloon to nearly 66 billion (US$ 82.9 billion) by 2020....

"Beyond finances, the Council also pointed out troubling medical aspects of a system lacking oversight and accountability. ...

"The report also discusses "grave inadequacies" in the way the health insurance system is currently managed. Compartmentalization, "confusion about who is in charge of what," and a "sometimes ridiculous accumulation of administration" were cited as major obstacles to efficiency. ...

":The High Council report warned that the current system of refunding medical expenditures "probably promotes some of the problems." As a result, the French are bracing themselves for changes that will likely curb their liberal access to medical specialists, treatments and drugs. They will probably have to pay more, too....

"Problems with the French public health care system became increasingly apparent in recent months. When Europe sweltered under a heat wave last August, for example, more than 15,000 people died in France, dwarfing the number of deaths in neighbouring countries. In December, a nationwide flu and bronchitis epidemic led to a shortage of hospital beds...."

Yeah, that French health care system really sounds great.

Posted by: jibjab on April 7, 2006 at 7:27 PM | PERMALINK
I do wish you would stop claiming to speak for all US proponents of universal health care.

I'm not.

You personally may understand that Britain and Canada and other countries with single-payer, "universal converage" health care systems are not desirable models for the US to follow, but other "US proponents of universal health care" keep making claims to the contrary.

I have seen people say they prefer their personal experience with either the British or Canadian systems to their personal experience with the US system. No one that you are arguing with here has proposed replacing the US system with either of those systems, or systems based on them, and you have attempted to claim that features particular to those systems prove general facts about how any government-run health system will turn out, without any evidence that those features do generalize to all universal systems in general.

What "model" are you proposing?

I not all too wedded to any one model, there are several that can be expected to do much better than the current US model. Both the French and the German models have much to recommend them in outline, though I wouldn't want to adopt either system "off the shelf", as it were. (The German model, being more decentralized and already following a federal structure, is perhaps more readily adaptable to the US, as the federal/state structure mimics systems like Medicaid in the US.)

The basic outline I'm mostly attracted to is a "universal baseline" model feature complete freedom of choice: provide a basic government coverage that covers a wide range of procedures, from any legal provider. Do nothing to restrict private fee-for-service medicine except to require that, where a service may be covered under certain conditions by the national system (perhaps with a waiting list), but is also provided on a fee-for-service basis providers cannot charge the national health system more for covered services than they charge fee-for-service clients, nor can they turn away clients for services covered under the government plan because they are using the government plan rather than paying fee for service.

Actually running healthcare facilities and providing services wouldn't be part of the new national system, though part of regional rate-setting mechanisms would be evaluation of need to attract additional services and providers.

Posted by: cmdicely on April 7, 2006 at 7:52 PM | PERMALINK

Total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, rose from 17.7 weeks in 2003 to 17.9 weeks in 2004.

Which part of averaged across all 12 specialities don't you understand? Why can't you see that's compatible with a 1-week wait for cancer surgery?

12 years ago I had an outpatient hospital biopsy that showed a strong possibility of cancer. I was in hospital within 2 days and had the exploratory op. on day 3. UK NHS, leading university hospital, North of England.

(The NHS has degenerated since then but I bet that particular hospital still moves fast.)

Posted by: jayann on April 7, 2006 at 8:58 PM | PERMALINK

cmdicely,

"No one that you are arguing with here has proposed replacing the US system with either of those systems, or systems based on them,"

Yes they have. Many people here have proposed that the U.S. should adopt a British or Canadian-style single-payer, publicly-funded health care system. In fact, even liberals who favor universal coverage but are opposed to single-payer are routinely attacked. Michael Kinsley was recently attacked by both Kevin Drum and many of his commenters here for daring to deviate from the far-left single-payer nanny-state orthodoxy on health care reform.

"I not all too wedded to any one model, there are several that can be expected to do much better than the current US model. Both the French and the German models have much to recommend them in outline,."

Ha ha ha. Did you see my last post? The French system, according to the French government itself, is "overburdened, wasteful and in urgent need of an overhaul," is chronically underfunded, inefficient, suffers from "grave inadequacies," and lacks oversight and accountability.

Yeah, that really sounds like a "model" we ought to adopt.

"The basic outline I'm mostly attracted to is a "universal baseline" model feature complete freedom of choice: provide a basic government coverage that covers a wide range of procedures, from any legal provider."

We already provide basic coverage to everyone. But your "complete freedom of choice ... from any legal provider" feature is economically absurd. It would be ruinously expensive. No country in the world guarantees that.

"Do nothing to restrict private fee-for-service medicine except ..."

In other words, you favor a multi-tiered health care system in which health care is heavily rationed on the basis of the ability of an individual to pay for it. Again, we already have that.

Posted by: jibjab on April 7, 2006 at 9:21 PM | PERMALINK

"Which part of averaged across all 12 specialities don't you understand?"

None of it. Which part of an average waiting time of 17.9 weeks (over 4 months) don't you understand?

"Why can't you see that's compatible with a 1-week wait for cancer surgery?"

Obviously, even with the Canada's appalling average wait time of over 4 months, some Canadians may get lucky and get treatment in a week. Others may have to wait even longer than 4 months. Still others may be denied treatment altogether, or die while they are waiting to receive treatment, or their disease may progress significantly while they are waiting to receive treatment, making effective treatment much more difficult or impossible by the time they get to the head of the line. Plus, of course, they may also be suffering from chronic pain and serious disability while they are waiting for treatment. Welcome to socialized medicine.

Posted by: jibjab on April 7, 2006 at 9:30 PM | PERMALINK

Stefan,

"Actually, it illustrates what happens when you put the British government in charge of health care."

Your belief that the Bush Administration, the Republican-controlled Congress, and an increasingly Republican judiciary would do a better job than the British government at running a single-payer national health care system is quite revealing, but it does seem to be rather inconsistent with your beliefs about Bush and the Republicans on every other issue.

Posted by: jibjab on April 7, 2006 at 10:52 PM | PERMALINK

jibjab, do you have any solutions? Obviously the ones presented here aren't good enough for you.

What is your opinion on how to fix or improve health care here in the US?

Posted by: grape_crush on April 8, 2006 at 9:45 AM | PERMALINK

"Obviously the [solutions] presented here aren't good enough for you."

"Solutions" that would make things worse. Interesting definition of "solution."

By the way, here is a summary of last year's landmark ruling of the Supreme Court of Quebec, Chaoulli v. Quebec, which struck down the provincial law banning private health insurance for services covered by Canada's Medicare system.

The court found that Canada's public health care system does not provide health care of a reasonable standard in a reasonable time, and that "the evidence adduced in the lower courts established beyond doubt that many Quebec residents face significant delays in obtaining treatment in the public health care system resulting in adverse physical and psychological consequences."

It also stated:

"Access to a waiting list is not access to health care.[T]here is unchallenged evidence that in some serious cases, PATIENTS DIE as a result of waiting lists for public health care. ... The evidence here demonstrates that the prohibition on health insurance results in physical and psychological suffering that meets the threshold requirement of seriousness."

Posted by: jibjab on April 8, 2006 at 5:15 PM | PERMALINK

More on the dire condition of the French health care service:

French health service on verge of collapse, says commission

Quote:

"A government commission has warned that without fundamental reforms France's national health service, rated the best in the world by the World Health Organisation, will collapse within the next 15 years.

"The high council on the future of national health insurance said yesterday that if present trends continued, the service - forecast to finish this year 11bn (7.3bn) in the red - will be a staggering 70bn (47bn) over-budget by 2020."

Adjusting for population size, in U.S. terms the French national health insurance system is running a deficit of $80 billion a year, and by 2020 will be running a deficit of $423 billion a year.

Yeah, we really should import the French system. We're so good at balancing our budget already, why not add another $423 billion to it?

Posted by: jibjab on April 8, 2006 at 5:37 PM | PERMALINK

"From Canada's own Fraser Institute..."

Oh please, jibjab, don't quote the corporate whores from the Fraser Institue at me, their alleged "research" is all bought and paid for.

And don't get too excited about that Quebec court ruling. Quebec does a lot of things differently from the rest of the country, and even in that case the ruling covered a narrow range of cardiac cases, and is open to a lot of interpretation.

Bottom line is still what I pointed out above; Cnaada's system costs about half of the US system and covers everybody. If you're really sick youget treatment, not just if you can afford it but if you need it.

Posted by: A Hermit on April 8, 2006 at 7:10 PM | PERMALINK

Hermit,

"And don't get too excited about that Quebec court ruling. Quebec does a lot of things differently from the rest of the country, and even in that case the ruling covered a narrow range of cardiac cases, and is open to a lot of interpretation."

The case wasn't about "a narrow range of cardiac cases." It was a challenge to Quebec's law banning private health insurance for services covered under Medicare. The challenge was successful. The law was held to be a violation of both the Quebec Charter of Human Rights and Freedoms and the Canadian Charter of Human Rights and Freedoms.

The case has already had a significant effect on Medicare, and it's likely to lead to major reform. The president of the Canadian Medical Association, Albert Schumacher, said the ruling "could substantially change the very foundations of Medicare as we know it."

As for "interpretation," the meaning of the court's statements "[T]here is unchallenged evidence that in some serious cases, patients die as a result of waiting lists for public health care" and "Access to a waiting list is not access to health care" seems pretty clear to me.

Posted by: jibjab on April 8, 2006 at 7:46 PM | PERMALINK

jibjab, the quebac case involved cardiac patients inquebec, and while the ruling can be read to apply generally it hasn't actually had any effect on anything in this country. You're being misled if someone's telling you otherwise.

There's no doubt there are problems in the Canadian system (I don't think I've said otherwise) but they are more related to underfunding (due to a decade of short-sighted cost cutting by both the federal and Provincial governments) and by teh privately run medical associations which are very resistant to solutions like greater use of nurse practitioners, and restrict the number of medical liscences issued each year.

By the way, any idea how many people in the US die every year because they don't have access to health care? Can you explain why life expectancy is lower and infant mortality higher, in the US than in Canada (or even places like Cuba for that matter...).

Health care in the US is the best in the world for those who can afford to pay the insurance companies. That leaves almost 16% of your population with no coverage. And you pay almost twicw as much as anyone else in the world. Something is not working.

Posted by: A Hermit on April 8, 2006 at 8:05 PM | PERMALINK

Here's a summary of some of the studies done recently on wait times:

http://www.chsrf.ca/mythbusters/pdf/myth17_e.pdf

"countries with parallel public and private healthcare
systems have the longest waiting times. For
example, England and New Zealand, which have
parallel private hospital systems, appear to have
larger waiting lists and longer waiting times in the
public system than countries with a single-payer
system, such as Canada.vii"

..."Studies in both Australia
and England have found the more care provided in
the private sector in a given region, the longer the
waiting times for public hospital patients.ix, x"

Posted by: A Hermit on April 8, 2006 at 8:15 PM | PERMALINK

For anyone interested, more of jibjab's misinformation is debunked here:

http://www.chsrf.ca/mythbusters/index_e.php

Posted by: A Hermit on April 8, 2006 at 8:19 PM | PERMALINK

Hermit,

You are a veritable spigot of misinformation. The Quebec case does not apply to "a narrow range of cardiac cases," it applies to all medicare services in the province of Quebec. Its immediate legal effect was to nullify the provincial legislation prohibiting private insurance for health services covered by medicare, and it has provoked debate and challenges to similar laws in other provinces. In response to the ruling, the Canadian Medical Association has now come out in favor of private insurance. (CMA supports private health insurance). Private, for-profit health clinics that allow people to jump ahead of the waiting lists have been operating in Canada for some time. They are technically illegal, but the government has been reluctant to enforce the law because of public dissatisfaction with the medicare system. The Quebec ruling will only make it even harder for the government to enforce the law.

Posted by: jibjab on April 8, 2006 at 10:11 PM | PERMALINK

Hermit,

"By the way, any idea how many people in the US die every year because they don't have access to health care? "

I don't know. How many people in Canada die every year because they don't have access to health care? Access to a waiting list is not access to health care.

"Can you explain why life expectancy is lower and infant mortality higher, in the US than in Canada"

If that's true, there are probably a number of reasons. International comparisons of mortality statistics can be problematic because of differences in recording practises. This is especially true for infant mortality statistics. Infant mortality and life expectancy are also influenced by many factors other than quality of health care servives, notably lifestyle factors like diet and exercise and the use of tobacco, alcohol and drugs. This issue has been discussed at length in other threads.

"Health care in the US is the best in the world for those who can afford to pay the insurance companies. That leaves almost 16% of your population with no coverage."

No, it does not leave 16% of the population with no coverage. The pool of uninsured Americans is a revolving door, not a static group of people. Someone who does not have health insurance today is likely to have it a year from now. The median length of time a period of uninsurance lasts is a few months. And many young, healthy people who could afford health insurance choose not to buy it, preferring to spend the money on other things instead.

Further, the uninsured receive health care services through a large network of free and subsidized health clinics and programs operated by the federal, state and local governments, and through private non-profit and charitable agencies. A study by the RAND corporation found that uninsured Americans receive about half the health care services that insured Americans do.

Posted by: jibjab on April 8, 2006 at 10:30 PM | PERMALINK

Hermit,

"Here's a summary of some of the studies done recently on wait times: http://www.chsrf.ca/mythbusters/pdf/myth17_e.pdf"

It's hard to understand the point of this. The alleged myth in this case is that "A parallel private system would reduce wait times in the public system." Since I never claimed this "myth" in the first place, I don't know why you're trying to debunk it. I never said anything about the effect of private health care on wait times in the public system.

Posted by: jibjab on April 8, 2006 at 10:36 PM | PERMALINK

Obviously, even with the Canada's appalling average wait time of over 4 months, some Canadians may get lucky and get treatment in a week. (etc.)

I agree that all the things you say are possible given an average wait of four months or more. But I think it more likely that (in Canada) waiting times for minor conditions are long, waiting times for cancer diagnosis and treatment, minimal.

A Hermit
..."Studies in both Australia
and England have found the more care provided in
the private sector in a given region, the longer the
waiting times for public hospital patients.ix, x"

Interesting. It fits with my general beliefs about how things work. But in Wales, where I live, there is relatively little private medicine and the waiting lists are MASSIVE.... (The Welsh Assembly Government couldn't organise a pissup in a brewery.)

Posted by: jayann on April 9, 2006 at 1:28 PM | PERMALINK

"It's hard to understand the point of this. The alleged myth in this case is that "A parallel private system would reduce wait times in the public system." Since I never claimed this "myth" in the first place, I don't know why you're trying to debunk it. "

We're discussing wait times relative to private vs. public insurance. It's clear that the private option is correlated to longer wait times. What's so hard to understand?

Posted by: A Hermit on April 9, 2006 at 1:44 PM | PERMALINK

The Quebec lawsuit was brought over the issue of cardiac care; the judge's comments you quoted referred to wait times for that narrow range of cardiac cases, not to health services in general. So while it's true that the principle established could be applied in other cases it is only applicable if the public system is not providing adequate coverage, which has not been proven to be the case outside of that narrow range of cardiac services in Quebec. To generalize from that to the whole Cnadian system is a sign of either ignorance or dishonesty.

And 16% is 16%, jibjab; that's the nuber of your fellow citizens without coverage at any one time; and it's a number that's getting worse. Just because someone is young, healthy and only temporarily without coverage doesn't make them any less vulnerable. There are huge wholes in the allegedly private US system, they are getting bigger and you're paying twice as much as anyone else in the world.

Posted by: A Hermit on April 9, 2006 at 1:57 PM | PERMALINK

jayann,

"I agree that all the things you say are possible given an average wait of four months or more. But I think it more likely that (in Canada) waiting times for minor conditions are long, waiting times for cancer diagnosis and treatment, minimal."

Wait times are probably shorter for serious conditions than minor ones, but I doubt they are "minimal." The finding of the court in the Quebec case was that some Canadians actually die as a result of the waiting lists, and even more suffer serious physical and psychological pain from the lengthy waits for treatment. I'm sure the same is true in Britain.

Posted by: jibjab on April 9, 2006 at 2:55 PM | PERMALINK

Hermit,

"The Quebec lawsuit was brought over the issue of cardiac care; the judge's comments you quoted referred to wait times for that narrow range of cardiac cases, not to health services in general."

No, they don't. You keep making this false claim because you don't know what you're talking about. The case wasn't about a "narrow range of cardiac cases," it was about the Quebec provincial law banning private health insurance for services covered by medicare. The court held that the ban on private health insurance in Section 15 of Quebec's Health Insurance Act and Section 11 of Quebec's Hospital Insurance Act are inconsistent with the Quebec Charter of Human Rights and Freedoms:

"Held: Section 15 HEIA and s. 11 HOIA are inconsistent with the Quebec Charter."

You can read the entire decision here: Chaoulli v. Quebec

I don't know where you got this bizarre idea that the ruling was only about a "narrow range of cardiac cases," but it's just total nonsense. Read the decision.

Posted by: jibjab on April 9, 2006 at 3:11 PM | PERMALINK

Hermit,

"And 16% is 16%, jibjab; that's the nuber of your fellow citizens without coverage at any one time;"

Yes, the operative phrase being "at any one time." It's not a static group of people, it's a revolving door. Someone who lacks insurance "at any one time" is likely to have insurance a few months later.

"Just because someone is young, healthy and only temporarily without coverage doesn't make them any less vulnerable."

Of course it makes them less vulnerable. Young people are much less likely to need health care than old people. Healthy people are much less likely to need health care than unhealthy people. And people who lack insurance for a short period of time are less likely to need health care while they are uninsured than people who lack insurance for a long period of time.

Posted by: jibjab on April 9, 2006 at 3:20 PM | PERMALINK

The finding of the court in the Quebec case was that some Canadians actually die as a result of the waiting lists, and even more suffer serious physical and psychological pain from the lengthy waits for treatment. I'm sure the same is true in Britain.

In Wales it most certainly is. In England, it may not be (waiting lists in England are now far lower than they were). But anyway I was talking about your comments on Canada; I have no intention of suggesting anyone should copy Wales and I think the entire NHS is as it stands not a good model; not because it's "socialized medicine" but because it's been so badly messed around by Thatcher and now by Blair.

Posted by: jayann on April 9, 2006 at 9:42 PM | PERMALINK

Shorter jibjab: I have no solutions, only criticism...

Posted by: grape_crush on April 9, 2006 at 11:38 PM | PERMALINK




 

 

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